What does it mean for patients and clinicians to be confronted with healthcare inequalities on a daily basis? In a recent article for the Guardian featuring an excerpt from her new book, Dr. Uché Blackstock outlined how her work at two emergency rooms in New York embodied the dichotomy between hospitals with and without wealth–and how this two-tiered system impacted her patients and her own work.
“In my 10 years working at Tisch and Bellevue, I can count on one hand the number of times anyone broke the silence about the existing segregated system of healthcare.”
– Dr. Uché Blackstock
NYU Tisch, the private hospital, had a patient population that was primarily wealthy, insured, and white. Their treatment was efficient, effective, and in some cases, proactive. Bellevue, the public hospital, took in more patients without insurance. These patients were more likely to face substance use disorders, mental illness, homelessness, and a general lack of access to care. Many were lost to follow-up, only to return months later with their conditions exacerbated by lack of care.
The “tale of two hospitals” trope is no secret amongst healthcare workers, either. Nurses at Bellevue report daily “NYU dumps” in which the “unwanted” patients would be diverted from the well-resourced NYU hospitals to the overburdened Bellevue. And in a 2022 New York Times article, 45 NYU Langone workers allege special VIP treatment for major donors, board members and trustees. Some of these VIPs even have their status marked in their medical charts encouraging preferential and expedited treatment.
This impacts not only patient care but also staff morale, as the overt classism can take a toll on providers otherwise dedicated to equitable care. According to the Times, 11 doctors have left NYU Langone in part because of the favoritism, and some are alleging the hospital took retribution for them holding the line against the expected favoritism. The hospital’s Chief of Hospital Operations denies all allegations of preferential treatment.
Allegations of preferential treatment based on class are particularly concerning given the social contract made with nonprofit hospitals like NYU Langone. These nonprofits that avoid millions in taxes per year are, in theory, supposed to use that capital to support the health and wellbeing of their communities. But more often than not, hospitals don’t do enough to invest in community health or cover medical costs for low-income patents to prevent them from falling into debt.
Some hospitals do the hard work of treating all patients, regardless of their ability to pay, while also following through on their community benefits. Bellevue, for example, ranks 8th in the country for community benefit due to their generous financial assistance policies and care for Medicaid patients.
If we want more equitable care, a stronger and healthier population, and a happier provider workforce, we need to incentivize more hospitals to be inclusive and invest more in their communities.