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A new study from CUNY SPH researchers puts forth a straightforward way to measure whether hospitals are providing fair access to care for low-income and uninsured patients.
In the article, published in Health Affairs Scholar, CUNY SPH doctoral student Deirdre Flynn and colleagues introduce the Proportional Share Index (PSI), a tool which compares the number of Medicaid and uninsured patients a hospital treats to the hospital’s share of beds in the city. If a hospital’s PSI is 1, it means the hospital is serving its fair share of these vulnerable patients. A PSI below 1 suggests the hospital is not doing its part, while a PSI above 1 means it is serving more than its share.
Researchers found that many of New York City’s well-resourced private hospitals, especially large academic medical centers, have a PSI below 1. This means they serve fewer Medicaid and uninsured patients than expected based on their size. In contrast, public hospitals generally have a PSI above 1, indicating they take on a larger share of care for these groups. The study also highlighted that these patterns contribute to ongoing racial and ethnic disparities in healthcare, since Black and Hispanic New Yorkers are more likely to be on Medicaid or uninsured.
“By making the PSI public, we hope policymakers and communities can better hold hospitals accountable and push for more equitable healthcare across New York City,” says Flynn.
