Here’s an analysis from the New York Times that explains yet another reason why Black patients sometimes fail to get the treatment they need.

In Why a Hospital May Shun A Black Patient, University of Pennsylvania health policy professors Amol S. Navathe and Harald Schmidt observe that hospitals prefer high pay-out procedures such as joint replacements and heart valve replacements, and would, generally speaking, rather limit unprofitable services such as psychiatry wards. 

“The approach used most frequently by health insurers to remedy this,” Navathe and Schmidt write, “is to financially motivate hospitals to control costs and improve quality by tying payments to achieving these goals. The aim is laudable and some programs do benefit disadvantaged populations. The Pennsylvania Rural Health Model, for example, is a collaborative effort by Medicare, Medicaid and private health insurers to provide a fixed payment to rural hospitals each year for all the health care services they provide. Because they’re receiving a fixed payment, hospitals can worry less about which services are more profitable and instead focus on preserving access and improving care for rural populations, whose health outcomes have lagged behind those of urban counterparts.

“But because a vast majority of programs that tie payment to cost, and quality goals aren’t focused on disadvantaged populations, they create incentives for hospitals to avoid patients from these groups.

For example, in the 1990s, the New York State Department of Health began grading surgeons who performed coronary bypass surgery and making their report cards available to the general public. The aim was to make outcomes more transparent and to help surgeons improve. But to this day, the initiative makes it harder for Black patients to get surgery. Why? Because statistically, outcomes are generally worse for Black patients because of larger issues of systemic racism. So surgeons avoid them to protect their scores.”

Find out more about how good intentions reap unintended consequences by reading the complete piece here.