Minority, uninsured and Medicaid patients are greatly underrepresented at academic medical centers in New York City, with those facilities highly segregated by ethnicity and insurance status, according to new research by the International Journal of Health Services.
Examining discharge data, researchers found that black patients in New York were two to three times less likely than whites to be discharged from academic medical centers. Uninsured patients were about five times less likely than those with insurance to be discharged from those hospitals.
The findings revived concerns that racial and ethnic minorities, who are more frequently uninsured or covered by Medicaid than most Americans, often encounter access barriers. The fear is that this contributes to racial and ethnic health disparities.
The study also looked at discharge data from academic medical centers in Boston and found that city's minorities were actually overrepresented in such hospitals.
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In New York City, academic medical center patients were older and more likely to be white and privately insured compared to patients at other hospitals. In Boston, academic medical center patients were younger, more likely to be privately insured and less likely to be white, relative to other hospitals' patients.
This pattern persisted after the implementation of the Affordable Care Act in 2014 when whites were still more than twice as likely as blacks to receive care at an academic medical center.
In both New York and Boston, Medicaid and uninsured patients were less likely than privately insured patients to be hospitalized at an academic medical center. But in New York, Medicaid patients were less than half as likely, and uninsured patients less than one-quarter as likely, as the privately insured to receive care at such a hospital.
The data show that 54 percent of black patients and 41 percent of other minority patients would need to shift their care to an academic hospital in order to achieve an equal distribution of patients by race and ethnicity.
Researchers could only guess at the possible causes. Financial pressures may lead academic medical centers to minimize the care they give to non- or low-paying uninsured and Medicaid patients, especially with Medicaid reimbursement rates remaining fairly low, they said. Those pressures could intensify as the number of high-paying commercially insured patients shrinks, and as the ACA phases down federal disproportionate share hospital payments. But that doesn't account for the ethnic disparities.
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One possible explanation is New York's extensive network of public hospitals, which researchers said may relieve pressure on private academic medical centers to care for disadvantaged patients. That would allow academic hospitals to focus on serving as referral centers for privately insured patients living in predominantly white, suburban communities.
To address the issue, researchers suggested that officials ensure adequate funding for the city's safety net hospitals -- altering the current allocation of the state's uncompensated care dollars that include DSH payments since much of those funds continue to flow to hospitals that provide little care for Medicaid and uninsured patients.
They also said officials should enforce requirements that academic medical centers governed as nonprofit, tax-exempt entities must deliver substantial amounts of free care as a condition for retaining their nonprofit status. That's been the practice in states such as Illinois, Nevada and Pennsylvania.
Academic medical centers represent only 5 percent of the nation's hospitals, the report said, but combined they account for one-fifth of the total hospital volume in the United States.
Twitter: @JELagasse