Detroit is Most Racially Segregated Hospital Market in the Country

The Lown Institute has ranked city hospital markets and individual hospitals by racial inclusivity.

A new report uses a racial inclusivity metric to examine how well 2,800 hospitals serve people of color in their surrounding communities.

Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 health disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.

The new report from the Lown Institute uses Medicare claims and U.S. Census Bureau data in a racial inclusivity metric. Vikas Saini, MD, president of The Lown Institute, described how the racial inclusivity metric works during a webcast yesterday.

"For every hospital, we used Medicare claims data to determine the Zip codes where that hospital's patients came from. We then used that data to define the perimeter around the hospital that represents the entire area from which patients could have come. We call this the hospital community area. Once we have a hospital community area, we then use the Census data to compare the demographics of the Zip codes of where patients actually come from for a hospital to the demographics of the whole hospital community area. This let's us see which communities are being over- or under-represented for any given hospital," he said.

Using this racial inclusivity metric, the Lown Institute was able to rank hospital markets and hospitals based on racial segregation.

The following 10 cities had the most racially segregated hospital markets, with at least 50% of their hospitals falling in the most or least racially inclusive categories:

1. Detroit, when considering service to all patients, it is 90% segregated

2. St. Louis, 77% segregated

3. Kansas City, Missouri, 75% segregated

4. Atlanta, 68% segregated

5. Philadelphia, 68% segregated

6. Washington, DC, 63% segregated

7. East Long Island, New York, 61% segregated

8. Houston, 58% segregated

9. Baltimore, 56% segregated

10. Manhattan, New York, 55% segregated

The 10 most racially inclusive hospitals in the report were as follows:

1. Lakeside Medical Center, Belle Glade, Florida

2. St. Charles Madras, Madras, Oregon

3. Metropolitan Medical Center, New York

4. Boston Medical Center, Boston

5. John H. Stroger Jr. Hospital, Chicago

6. The University of Chicago Medical Center, Chicago

7. Harlem Hospital Center, New York

8. Truman Medical Center Hospital Hill, Kansas City, Missouri

9. Methodist Dallas Medical Center, Dallas

10. Grady Memorial Hospital, Atlanta

The 10 least racially inclusive hospitals in the report by rank were as follows:

2765 Fairfield Medical Center, Lancaster, Ohio

2766 Adventist Health Sonora, Sonora, California

2767 Riverside Medical Center, Kankakee, Illinois

2768 Greenwich Hospital Association, Greenwich, Connecticut

2769 Palos Community Hospital, Palos Heights, Illinois

2770 St. Elizabeth Dearborn Hospital, Lawrenceburg, Indiana

2771 St. Elizabeth Fort Thomas, Fort Thomas, Kentucky

2772 Mercy Hospital South, St. Louis

2773 Peterson Regional Medical Center, Kerrville, Texas

2774 Cass Regional Medical Center, Harrisonville, Missouri

Reflections on racial inclusivity

The analysis is a reflection of structural racism in healthcare, Saini said during yesterday's webcast. "I view the data and the method as a measure of structural racism. For me, the 'structuralness' of it means that it is deeply embedded in history, patterns of residential segregation, bifurcation of the labor market, and bifurcation of the insurance market. Then you get these patterns of segregation."

Race plays a role in elective surgery, he said. "With elective surgery, although it declined in 2020 because of the pandemic, we saw a pattern. What we saw was that elective patients were drawn from whiter and wealthier areas in a hospital's surrounding community. That is not a surprise—70% of hospitals were less inclusive for elective patients than for their population as a whole. Elective surgeries are part of a selective, biased process."

Financial incentives drive racial inclusivity in healthcare, Anthony Iton, MD, JD, MPH, senior vice president of healthy communities at The California Endowment, said during yesterday's webcast. "We have constructed a market-justice-oriented healthcare system that does not respond to the needs of people—it responds to the privilege of people and their ability to pay."

Segregation in hospital markets and at individual hospitals is not the result of malicious healthcare leadership, Iton said. "When you see this over and over again, you are looking at a pattern—you are not looking at a bunch of bad actors. You are looking at a normal reaction to a set of incentives. The problem is the incentives. There are not bad people running hospitals—they are doing exactly what anybody would do under the constraints."