Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Custom Media Event: ESG Summit
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Patient Care
May 25, 2021 05:00 AM

Urban hospitals tend to cater to white patients, analysis finds

Alex Kacik
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    Urban hospital markets are more likely to segregate patients based on race, a new analysis shows.

    Hospitals in metro markets tend to serve a whiter, wealthier patient mix, while others predominately serve patients of color and lower-income individuals, according to Lown Institute's analysis of Medicare claims spanning 2013 to 2018 across 3,200 hospitals. In the top 50 most inclusive hospitals, people of color made up 61% of patients on average, compared to 17% at the bottom 50 hospitals. Researchers ranked hospitals by comparing how well the demographics of a hospital's Medicare patients matched its surrounding communities.

    The most inclusive and least inclusive hospitals can be blocks away from each other. Metropolitan Hospital Center is East Harlem, N.Y., is around a mile away from one of the least inclusive hospitals, Lenox Hill, in the Upper East Side. Metropolitan serves 77% people of color while Lenox Hill serves 33%.

    "It is a form of segregation, to be blunt," said Dr. Vikas Saini, president of the Lown Institute, describing many markets as the tale of two hospitals. "In big cities where there was a lot more diversity, there was a real tendency for some hospitals to cater to primarily wealthier, whiter and more educated patients. That left other hospitals to take care of the poor, less educated and minority patients."

    The hospital markets in Baltimore and Philadelphia were disproportionately less inclusive. Baltimore had nine of the most segregated hospitals and only two of the least segregated; Philadelphia had a 19-to-6 ratio.

    The least inclusive hospitals served a patient population that had a $29,000 annual income above the market average. The most inclusive treated patients that earned nearly $27,000 less than the market average. Academic medical centers often treated patients on both ends of the spectrum.

    There may be patient preferences in play that are hard to account for, said Terry Fulmer, president of the John A. Hartford Foundation, positing whether patients choose settings where doctors and nurses reflect the diversity in their neighborhoods.

    "Having said that, it is unacceptable to have health systems work with populations selectively," she said. "We can begin to bridge gaps by insisting on new accountability measures that address inequity and relate to hospital quality and safety scorecards."

    Racial disparity has systemic roots. Discriminatory lending practices have segregated communities. Minorities have had fewer chances to secure higher paying jobs with healthcare-related benefits.

    Many hospitals have evolved to cater to certain kinds of patients and exclude others, Saini said. They would also seek patients who may generate more revenue, he said.

    "They tend to focus on paying customers and those with commercial insurance, who tend to be white," Saini said. "By the time they reach 65, they've already established which doctors they would see. When you see these results, it's as good a definition of structural racism as you will see."

    COVID-19 compounded those inequities. Transmission rates were higher based on the kinds of jobs people had and houses they lived in, among other social factors. Hospitals that predominantly served those patients were overwhelmed, Saini said.

    "That's a threat to all of us," he said. "Hospitals with a history of serving communities of color needed refrigerator trucks to hold bodies of deceased patients, while wealthier hospitals nearby had empty beds."

    Hospitals should factor these social inequities into where they open clinics, marketing campaigns, what kinds of staff and doctors they hire and financial aid guidelines, Saini said. Providers should recruit from poorer, rural and minority communities. Executives should involve community leaders and use inclusivity metrics as they structure their operating models. Regulations should incentivize a diverse patient mix.

    Then, hospitals need to be held to those standards, experts said.

    "You have to make some calls about how much revenue and high margins matter to you compared to the broader social mission," Saini said. "As long as there are differences in the kinds of payments hospitals expect to receive based on the kind of insurance patients have, it is tough to solve the problem."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    CVS pharmacy
    CVS Caremark returns Eliquis to formulary after outcry
    CN_20220411p19_pregnant black woman_iStock_i.jpg
    New York hospital unknowingly advised patients against birth plans for years
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
      • Custom Media Event: ESG Summit
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing