Overview of the health care system in New York City
Healthcare in New York City describe the health care services available in New York City, the largest US city with a population of over eight million.[1]
Many health care systems in place in New York developed from nonprofit charitable organizations.[2]
Insurance
The US health system does not provide health care to the country's entire population.[3] Instead, most citizens are covered by a combination of private insurance and various federal and state programs.[4] As of 2017, health insurance was most commonly acquired through a group plan tied to an employer.[5]
In 2010, the health department began a program to document health disparities. The first report focused on disparities in life expectancy and death, and stated that death rates were 30% higher in the poorest New York City neighborhoods than the wealthiest.[11] A 2011 report examining breast, colorectal, and cervical cancer stated that while breast cancer diagnoses were highest among high-income white women, low-income Black women had the highest rate of death.[11]
Emergency care
In 2000, a report from The Commonwealth Fund found that nearly three-quarters of emergency room visits in New York City were for non-emergent healthcare needs or could have been treated in a primary care setting. The report concluded that reducing strain on hospital emergency departments, the city's primary care system required significant expansion and barriers to care for low-income patients and those without health insurance needed to be reduced.[12]
Access
Access to healthcare continues to be an issue. The cost of living in the city has forced many New Yorkers to opt out of insurance because of the high costs.[citation needed] New Yorkers living in low-income communities or who are unemployed have limited access to quality healthcare.[12] The NYC Health + Hospitals program attempts to improve healthcare availability for these residents.[13]
The pandemic exposed health care disparities. Prior to the pandemic, the Upper East Side of Manhattan had 27 times more primary care providers than Elmhurst and Corona, or eight times the city average. The same Queens communities had a COVID-19 infection rate four times that of Manhattan's East Side and a death rate six times higher.[21] Multiple reports showed that minority communities in New York City were severely affected by COVID-19, partially due to higher population density in minority-dominated neighborhoods and a higher rate of comorbidities.[22][23]
COVID-19 testing
A 2020 study found that COVID-19 testing in New York City was more egalitarian than income distribution. However, the same study found significant disparity in test results across income levels. Comparing the poorest ZIP codes to the wealthiest revealed a 38 to 65 percent difference in negative tests.[24]
Vaccination
Early distribution of COVID-19 vaccines faced logistical obstacles including supply issues.[25] In some cases, concerns over eligibility led vaccine doses to be discarded. In early January 2021, New York State responded by expanding its eligibility criteria.[26] Despite this, short supply, extended wait times, and difficulties with eligibility and registration remained obstacles.[27] In addition, early data showed demographic disparities in vaccine distribution. As of January 31, 2021, 48% of people receiving vaccine doses were reported as white, compared with 11%, 15%, and 15% of Black, Asian, and Latinx individuals respectively, though 40% of vaccine recipients at the time had not had demographic data collected.[28] Vaccine hesitancy has been an issue, especially in low-income neighborhoods. Many Black New Yorkers cited fear and suspicion of the government entities advocating vaccination.[29] Vaccination rates improved significantly with city and state mandates.[30]
^Rosner, David (1982). A once charitable enterprise : hospitals and health care in Brooklyn and New York, 1885-1915. Cambridge [Cambridgeshire]: Cambridge University Press. ISBN0521242177.
^Access to health care in America. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Millman M, editor. Washington: National Academies Press; 1993.
^ abBillings, J; Parikh, N; Mijanovich, T (Nov 2000). "Emergency department use in New York City: a substitute for primary care?". Issue Brief (Commonwealth Fund) (433): 1–5. PMID11665698.