How the Covid 19 has exposed racial disparities in health care

The death rate for black patients diagnosed with COVID-19 would be 10% lower if they received care in the same hospitals as white patients, according to a new Penn Medicine study adding to growing evidence of racial inequalities in U.S. health care

In the study published last month in JAMA Network Open, researchers examined Medicare data from more than 44,000 patients admitted to nearly 1,200 hospitals last year and found that the significantly higher death rate for black patients was eliminated. as they adjusted to the location of the hospital. .

Because patients often go to hospitals close to their homes, the study highlights the results of structural racism in utter relief: Low-performing hospitals, struggling to find adequate income and resources, are most often found in economically poor communities. disadvantaged.

"This is truly a story of racial segregation in homes that has plagued this country for a century," said Dr. David Asch, lead author of the study and executive director of Penn Medicine's Center for Healthcare Innovation. .

Asch, who is also a professor of health management at Wharton, spoke about the research with Wharton Business Daily on SiriusXM. (Listen to the podcast above). He said the results are not that surprising to medical professionals, because it is well known that the health care system is uneven. But consumers may be surprised to learn how deep the inequality is.

"This is truly a story of racial segregation in homes that has plagued this country for a century." –David Ash

“Of course, a lot of people assume that the doctors, hospitals, and nurses are great, and when you go there, you get unified care. That's the experience that people often have at, say, McDonald's, who have worked very hard to provide a very consistent experience. You can walk into any McDonald's and the fries will be uniformly excellent, "Asch said." That's not really the case with hospital care. "

He even noted that the novelty of the coronavirus exacerbated the variance as hospitals had to move quickly to meet the challenge. Working to improve health care is the "relentless task" of professionals, legislators and insurers, she added. "But as medicine has advanced, that progress has been uneven in hospitals. Some hospitals have a harder time catching up with the best."

An Unequal America

African Americans suffer from COVID-19 in greater numbers due to a wide variety of factors: access to care, lower income levels, occupations with a higher risk of exposure to the virus, and higher rates of hypertension, diabetes, and obesity.

Even those comorbidities "are probably products of long-term discrimination. It's a pretty tangled web, but that tangled web in the middle reveals significant racial differences," Asch said.

Asch noted from previous research that hospitals that serve the majority of the black population have worse outcomes for all of their patients, compared to hospitals that serve the majority of the white population. He said better public policies are needed to close the racial divide in the healthcare system, drawing an analogy to the way public education is funded: Most schools receive property tax revenue, so how much The richer the community, the higher the dollars to fund the schools. finances in that area.

"The same goes for health care," Asch said. "We fund health care in an unusual patchwork, but mostly through insurers and if patients have commercial insurance, which pays better, or Medicaid, which often pays less than cost, or Medicare, which is at some point intermediate. That says a lot about the resources the hospital can develop and deploy for the community. "

"The differential burden of COVID across the country will soon depend less on race and more on vaccination and, in turn, on political ideology." - David Ash

The Next Chapter of COVID

In the progression of the pandemic, one statistic has remained: older patients and men have fared worse than younger patients and women, regardless of race. Vaccines and the best therapies have dramatically reduced the death rate from the disease.

As the pandemic enters its second year and the most dangerous Delta variant emerges as the dominant strain, the greatest threat to the progress already made comes from those who are unwilling to get vaccinated, Asch said. Current vaccines are effective against the Delta variant, according to experts.

Asch said there is no single story about COVID-19 in the US The vulnerability of any community depends on the level of vaccination.

"And that, frankly, has tragically become a political problem rather than a medical or public safety problem," he said. Unvaccinated areas “can become powder magazines for contamination. I bet the differential burden of Covid across the country will soon depend less on racial issues and more on vaccination and, in turn, political ideology. "