Most U.S. hospitals are still disproportionately treating white patients for common services, a report published Tuesday shows, despite serving racially and ethnically diverse communities.
A U.S. News & World Report analysis of federal data from 2015 through 2019 compared more than 1,400 hospitals to the racial or ethnic makeup of each hospital’s surrounding community.
Researchers found racial and ethnic minorities were under-represented among patients in roughly 4 out of 5 hospitals in the country. The findings were released as part of the U.S. News’s annual Best Hospitals rankings and have been published on each hospital’s profile.
“Health is incredibly tied to social factors which include economic factors and language barriers, and there are enormous disparities,” said Ben Harder, managing editor and chief of health analysis at U.S. News. “The health of our populations is based on factors that should not have an impact on health and that’s what inequity is.”
The U.S. News analysis used data from the federal Medicare program, which insures more than 60 million Americans and permits patients to seek care at many public and private hospitals. Non-local residents were excluded to avoid misjudging hospitals that draw patients from outside their local community, which could inflate the disparity gap.
Only 29% of hospitals in the analysis treated a proportion of Black patients that was comparable to or higher than the proportion of Black residents living in the community. Only 18% and 5% of hospitals met that bar for Hispanic and Asian/Pacific Islander patients, respectively.
The analysis also found Medicare-insured residents who are Black experienced more hospitalizations that might have been avoidable if they’d had access to better preventative health care compared to similarly insured residents of other races.
While most hospitals served a smaller share of minority patients than was reflected in the racial and ethnic makeup of their surrounding community, some hospitals served a larger share.
At Atlanta’s Grady Memorial Hospital, 82% of Medicare patients who underwent elective procedures were Black. In Dallas, where 17% of residents with Medicare are Black and 4% are Hispanic, 40% of patients treated at Parkland Health and Hospital System were Black and 16% were Hispanic.
“This is the work that we do,” said Shannon Sale, chief strategy officer at Grady Memorial Hospital. “The population that we serve has unique needs and higher barriers to accessing health care and we’ve worked for years to help them.”
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Sale says the hospital studies the needs beyond health care – like food insecurity, access to housing and transportation – and works in partnership with other community service organizations to address those needs.
“What we really want to be is in the business of preventing disease and to do that you have to get to the other end of the spectrum,” said Jessica Hernandez, senior vice president for community integrated health at Parkland Health & Hospital System.
Health systems achieving better health equity venture into the community to personally implement public health strategies before a patient takes their first steps into a hospital, Harder said.
They’re not “just hospitals that provide care within the four walls but an institution that looks beyond and tries to meet the patients where they are,” he said. “All of the things that we would have historically thought as public health measures, they’re leading the charge of addressing the needs of their communities and taking more responsibility in these public health components.”
Many of the hospitals making the most progress in health equity aren’t listed on the U.S. News honor roll this year. For the sixth consecutive year, the Mayo Clinic in Rochester, Minnesota claimed the number one spot on the Best Hospitals Honor followed by the Cleveland Clinic and UCLA Medical Center.
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“We’re fortunate in the United States, we have the very best health care technology but it’s only a service to the population of the country if it can be accessed and of value to all members of the population,” said Dr. Andrew Limper, interim chief value officer for the Mayo Clinic. “It’s great to have all this technology and expertise but it really has to be fairly distributed and available to everybody… We’re committed to bring equitable care.”
The health inequities revealed in the data could be caused by a decreased access to health care, patient-doctor communication barriers, lack of trust and other factors, researchers said, and not necessarily intentional discrimination.
But studies have shown that when patients of different races and ethnicities gravitate to different hospitals, minority patients typically receive care at lower-quality hospitals contributing to worse outcomes for patients.
“Equity is really important,” said Dr. Tomislav Mihaljevic, chief executive officer and president at the Cleveland Clinic. “We feel very strongly that every life deserves a world class care and we have put tremendous amount of effort to reach out to communities that we serve to tailor access and treatment.”
U.S. News plans to expand their health equity analysis to not only include access but also outcomes and how hospitals are investing in the needs of their communities, Harder said.
“This is the first unveiling of a set of measures that we intend to grow over time and look at other aspects of health equity so we can have a broader understanding of where disparities exist and how hospitals are addressing them,” he said.
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.