Background

Academic medical centers (AMC) are often viewed as providing exceptional patient care and are often among the top ranked hospitals in the country. While historically they have provided significant care to uninsured and Medicaid patients, there is concern of a trend of decreasing care at AMCs for such patients. 

Clinical Question

Are there significant disparities in access to care at AMCs in NYC and Boston based on racial/ethnic and payer differences?

Design

Retrospective analysis of database information including all inpatients over 18, discharged from AMC in NYC (2009 and 2014 data) and Boston (2009 data).

Primary Results

  • In NYC, non-white patients were less likely to be discharged from an AMC versus white counterparts. 
  • In NYC, Medicaid patients half as likely, and uninsured patients less than one-quarter as likely to be discharged versus private insurer counterparts. 
  • In Boston, non-white “more likely” to be discharged from AMC

Strengths

  • Used large databases (NYC- Statewide Planning and Research Cooperative System (SPARCS) data- base. Boston- all-payer discharge data from the Massachusetts Center for Health Information and Analytics (CHIA))
  • Multi-center analysis

Limitations

  • Comparing hospitals in different health systems is subject to numerous issues as the populations, insurance status etc are markedly different
  • The authors equate AMCs with quality care which may be a flawed assumption
  • Making broad conclusions from cross-sectional data is suspect at best
  • Difficulty of interpreting data from Boston with unique position of BMC as merger between safety-net hospital and private AMC
  • Difficulty interpreting insurance data from two different payer-models as well as large change of ACA implementation in 2014 data. 
  • Non-standard classifications of race

Other Issues

  • Two of the authors are the founders of the Physicians for a National Health Program (PNHP) which represents an intellectual conflict of interest

Author's Conclusions

"Our analyses of inpatient discharges provide evidence that minority, uninsured, and Medicaid patients are markedly underrepresented atNew York City AMCs and that the city’s hospitals remain highly segregated by race/ethnicity and insurance.”

Our Conclusions

There are many factors that affect patient demographics in hospital settings. More research is needed to explain health disparities, but there may be structural limitations within AMCs that facilitate such disparities.

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PNHP: Hospitals in NYC Segregated by Race and Insurance Status: New Study