Separate But Not Equal

A recent study, published in the International Journal of Health Services, suggests people of color don’t have equal access to academic medical centers. Researchers from Hunter College of The City University of New York, Boston Medical Center, and Harvard Medical School looked at who is receiving care at teaching hospitals (including their own institutions).

AMCs offer some of the best research-based and specialized care in the country. Historically, they’ve been seen as a haven for minorities, the uninsured, and those with Medicaid; by offering access to cutting edge care, and being legally required to serve the disadvantaged. 

But, the recent study found New York City’s AMC patients were more likely to be older, white, and privately insured. In fact, white residents in the city were three times more likely than blacks to receive care at a teaching hospital. Surprisingly, in Boston, patients were more likely to be younger people of color (though most of them also had insurance).

What’s at the root of this apparent racial segregation? Several factors seem at play. 

New York City has the nation’s largest public hospital system. According to the New York City Health and Hospitals Corporation, nearly 70 percent of their patients are on Medicaid or are uninsured. Those patients represent communities more likely to turn to emergency rooms for healthcare. Since many academic medical centers don’t have public ERs, these patients are less likely to frequent AMCs.

In New York, public hospitals are also more likely to be located in underserved communities, and geographic proximity impacts where people get medical care. Unfortunately these hospitals rank poorly for quality of care, according to a 2016 Centers for Medicare and Medicaid Services report.

Boston has only one public hospital, making that city’s AMCs more likely to serve minority patients, but “the results were not so encouraging for Boston either,” Roosa Tikkanen, the lead author of the study, told Modern Healthcare. Now a policy analyst at the University of Massachusetts Medical School, Tikkanen said if researchers excluded Boston Medical Center — a hybrid academic medical center and public hospital — the results would’ve been quite different. That’s because black residents were 40 percent less likely than whites to be treated at any of the city’s other teaching hospitals.

Why does this matter? AMCs enjoy significant tax breaks with the supposed trade-off that they provide care for the underserved members of their communities. Yet a 2014 New York Post article revealed that many of the nation’s biggest teaching hospitals spend less than 2 percent of their revenue on charity care (yet pay their CEOs handsomely). 

The authors of the recent report argue that these teaching hospitals should be held to higher standards, and forced to provide a significant amount of free care to those who need it, in order to maintain their nonprofit status. Although the racial segregation doesn’t appear deliberate, the researchers still called on academic medical centers, including their own institutions, to acknowledge that it does exist — and take steps to end it.