AMA Journal of Ethics, January 2023
AMA Journal of Ethics ®
January 2023, Volume 25, Number 1: E3-6
Denisse Rojas Marquez, MD, MPP and Hazel Lever, MD, MPH
https://journalofethics.ama-assn.org/article/call-health-care-desegregation/2023-01
Structural racism within health care has become a recent priority for many academic health centers (AHCs) nationally. In this theme issue, we suggest that one important way to prioritize this topic is by assessing ways in which de facto racial segregation continues
in health care today. Segregation has not received much attention, but practices of sorting patients into different tracks of care within a facility or system by insurance status (1), race (2), and other social demarcations exist, which is what we shall call segregated care in this theme issue. While sanctioned racial segregation in hospitals ended with the Civil Rights Act of 1964 and subsequent implementation of Medicare in 1966 (3), health care organizations continue to practice de facto racial segregation today.
Beyond individual institutions, segregated care exists at the city level through unequal resource distribution and health insurance inequity (4, 5).As students in an AHC, we witnessed segregation of our patients daily. Patients with Medicaid are triaged to resident and fellow clinics—staffed by trainees—while privately insured patients largely receive care in another building and are seen by faculty,
attending physicians who have completed their training and certifications. It is important to acknowledge that segregation based on insurance is a de facto proxy for segregation
by race far too often. In New York State, 18% of nonelderly Medicaid recipients are White, whereas an estimated 62% of nonelderly patients with employer-provided
coverage are White (6, 7). One study found that resident physicians in an AHC saw disproportionately more Black and Latinx patients than did attending physicians, as well
as disproportionately more patients on Medicaid (8). When physicians-in-training see disproportionate numbers of patients of color compared to fully trained and licensed physicians, undoubtedly there are differences in quality of care that patients receive. In our conversations with other students and health justice advocates, we came to learn that this practice is common at AHCs, both in New York City and throughout the United
States.
Continue reading here: https://journalofethics.ama-assn.org/article/call-health-care-desegregation/2023-01