UHF Health Care Services Symposium Focuses on Inequities During Pandemic

The glaring racial and economic inequities in the U.S. health care system, magnified by the coronavirus pandemic, were the main topics of the 31st Annual Symposium on Health Care Services in New York: Research and Practice, jointly sponsored by United Hospital Fund and GNYHA.

As speaker after speaker pointed out, communities of color have faced numerous challenges during the pandemic: a lack of disposable income, paid leave, and child care; inflexible work schedules; furloughs; layoffs, and housing and food insecurity. Such hardships have put these communities at a higher risk of contracting COVID-19 and have exacerbated disparities in a health care system with a long history of underserving these populations.

The symposium was held as a webinar for the first time and viewed by some 130 attendees over two afternoon sessions on October 26 and 28.

Katherine Baicker, PhD, Dean and Emmett Dedmon Professor at the University of Chicago’s Harris School of Public Policy and a leading scholar in the economic analysis of health policy, kicked off the first day of symposium. “We need to think about how to get more value out of the system,” Dr. Baicker said. “The goal is to get as much health out of the system for every dollar we spend.”

Katherine Baicker, PhD, Dean and Emmett Dedmon Professor at the University of Chicago’s Harris School of Public Policy

One way to do this, suggested Dr. Baicker, is by covering the uninsured—a critically urgent challenge during the pandemic. She described the findings of the Oregon Health Insurance Experiment, a unique randomized controlled study of the effects of Medicaid coverage on health made possible by a lottery process used in 2008 to expand Medicaid coverage in the state, with those not chosen in the lottery as the control group. 

The study found greater use of all types of health care services, including preventive care, by the population enrolled in Medicaid when compared to those who remained uninsured. Hospital admission rates, for example, increased by about 30 percent for those covered by Medicaid. “The Oregon expansion illustrates the tradeoffs of health care reform,” said Dr Baicker—lots of incremental benefits, but no cost savings. Nevertheless, she believes that expanded health insurance is worth the cost. “Don’t say universal coverage is free,” she said. “Say it’s worth the money, and let’s find the money to do it."

The second day of the symposium featured a keynote by Moro O. Salifu, MD, Professor and Chairman of the Department of Medicine and Chief of the Division of Nephrology at SUNY Downstate Health Sciences University and Director of the Brooklyn Health Disparities Center. Dr. Salifu described the many challenges facing communities of color in the U.S., as well as the long history of discriminatory laws that have kept them from gaining access to health care and that have created a mistrust of health providers.

Health care providers must step up their screening for social determinants of health, such as inadequate housing, food scarcity, and the stresses of poverty, Dr. Salifu said. He also recommended that hospitals partner with community-based organizations to provide the services that such screening would inevitably uncover.

Moro O. Salifu, MD, Professor and Chairman of the Department of Medicine and Chief of the Division of Nephrology, SUNY Downstate Health Sciences University

Such a partnership was described in a research presentation on the first day of the symposium. Andrew Nastro, MD, Fellow, Academic General Pediatrics at Bellevue Hospital Center-NYU Langone Health, detailed a project that grew out of his participation in UHF’s Partnerships for Early Childhood Development Initiative.

Vivian Hsing-chun Wang, a PhD student at New York University’s School of Public Health, presented research on the second day of hte symposium about the public’s views on the restriction policies put in place to address COVID-19 in the U.S. Her team found wide variations in support for such policies based on age, race, political party affiliation, and even if the respondent closely followed the news.

Both days featured several research presentations on how the pandemic is affecting the health care workforce and care across a variety of settings, chosen by a team of expert judges.  Lightning rounds of panelists discussed innovations in treatment and procedures developed during the pandemic and the use of telehealth and other forms of virtual care.

The full program for the symposium can be found here.