Boston Globe Op-ed: Amidst COVID-19, Hospital Siting Decisions Have Equity Implications

Matthew Freeman

May 6, 2020

One of the most telling aspects of the COVID-19 pandemic has been its disparate impact on minority communities in the United States. At least three factors seem to be at work in the elevated death rate: uneven access to health care, greater prevalence of preexisting (and often inadequately treated) comorbidities, and greater likelihood of on-the-job exposure. Writing in the Boston Globe last week, CPR Member Scholar Shalanda Baker, together with co-authors Alecia McGregor, Camara Jones, and Michelle Morse, point out yet another way that the pandemic is taking a particular toll on low-income communities and communities of color.

They point to a decision by a for-profit hospital chain, Steward Health Care, to convert Carney Hospital in Dorchester, Mass., which under normal conditions serves as a safety net hospital for low-income residents, into a dedicated COVID-19 hospital.

The co-authors note that while the decision was initially deemed a "welcome expansion of hospital capacity in response to the outbreak," it has other notable downstream impacts. Viewed through a different lens, the choice of Carney means that low-income Dorchester residents won't have access to their nearby hospital for non-COVID-19 purposes, but other Steward hospitals in the area will be able to resume more profitable procedures. They write,

Dedicating Carney to critically ill COVID-19 patients appeared to us to be a move to free up Steward’s other Massachusetts hospitals to schedule better-reimbursed procedures, though the hospital’s management says this is not the case. Although the Emergency Department remains open, the move also, critically, temporarily removes other types of inpatient care from the local community. Viewed more cynically, it may be a strategic way, in the middle of a crisis, to turn Steward’s money-losing location into a potential source of additional revenue.

They go on:

Over the last several decades, urban hospitals have been more likely to close in majority-Black neighborhoods than in other locales. People of color and low-wealth individuals are also disproportionately affected by the underlying conditions that have been identified as risk factors for critical complications of COVID-19. Thus, the accessibility of ICU beds in this time is paramount, and this critical care must be distributed equitably.

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