What does a desegregated health care system look like and how can we get there? This was the theme for the Chats for Change on March 2, 2021.
We gathered.
Nearly 100 students, faculty, care providers, hospital leadership, and administrators gathered to share their perspectives and knowledge on the issue. We had representation from across Mount Sinai’s campuses as well as folks from other institutions in NYC!
We framed the conversation.
We began our conversation by setting a common framework for the dialogue by defining segregated care: the separation of patients based on insurance status. This exists when patients who have public insurance are seen by different physicians, in a different location, or at different times than patients with private insurance. This segregation by insurance negatively impacts patient experience and how students learn about medicine. This separation occurs both within institutions and between the public and private hospital systems.
The systemic effects of racism, white supremacy culture, and capitalism are embedded into differences in insurance status. As a result, by segregating by insurance, we are segregating patients by race. One-in-four non-elderly New Yorkers have medicaid, and among those Medicaid enrollees, white people are under-represented and people of color or over-represented. Segregated care perpetuates racism and inequity.
As the theme suggests, our goal was to imagine a desegregated, equitable system, which requires us to move beyond the way the system is currently set up. So we moved on to brainstorming the different avenues of care in New York City to acknowledge what is currently in place. Responses ranged from the community health centers, urgent care, private practice, to the internet, with hospitals making up the overwhelming majority.
We dialogued:
In small groups, we discussed the following questions:
- What would a desegregated system look like across NYC, assuming there are truly no boundaries?
- Who might benefit from a desegregated health care system?
- What is an immediate actionable change that can be made to bring us closer to a desegregated system?
The point wasn’t to be bogged down in the barriers. The point was to envision a better future. As such, we framed the conversation as aspirational. Our dialogue didn’t need to be feasible or realistic. We focused the purpose on envisioning who and how people would benefit from a desegregated system and what that would look like, rather than how we would get there. Then, we spoke about changes that could be made to get us closer to what we envisioned.
We aspired:
Individuals brainstormed and logged in their responses. Here are some of the themes that arose:
Desegregated care would mean:
- Equity in access to resources and longitudinal care
- Educating physicians to treat a diverse patient population
- A renewed focus on preventative care
- All people, regardless of insurance or immigration status, would be able to access care
We brainstormed ways to get there together:
- Mount Sinai should/will publicly denounce Segregated Care both institutionally and across NY.
- Full price transparency mandated to all hospitals/clinics/healthcare systems to promote using money in a more equitable manner.
- Lower the debt burden for medical students to prevent the physician financial stress that contributes to segregated care and diversify our physician network.
- Move towards a single payer model for healthcare.
We will take action:
- Acknowledge and actively address biases.
- We will continue the conversation and note differences in our training, work, and community that are grounded in structural racism and segregated care
- Talk to peers working at different institutions to see how we can work together towards a desegregated, more equitable system
- Instead of focusing on barriers, we will focus on the immediate actionable changes that can be made.
We will continue the conversation:
If you are working on desegregation and integration at Mount Sinai or any other institution, the Segregated Care Work Group would love to hear from you – please email Emily Xu (emily.xu@icahn.mssm.edu) and Paige Cloonan (paige.cloonan@icahn.mssm.edu) to set up a time to meet with us! Please also reach out if you’re interested in working on a project with us! We welcome everyone – regardless of role or institution.
Do you have any experiences with segregated care as a provider, patient, or trainee (student, resident, fellow) that you would like to share? Feel free to contact us directly, or submit your story anonymously here.
This post was written by Emily Xu and Paige Cloonan, medical students and co-facilitators of the Chats for Change session, “Desegregating Care: Imagining an Equitable NYC Healthcare System.”
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