Black and Latino New Yorkers receive lower quality health care than whites because of racial inequalities built into the health care system, according to a report by Bronx Health REACH. The researchers are calling the treatment minorities receive "medical apartheid."

"I totally believe that the underlying factor here is racism," said Maxine Golub, the BronxHealth REACH project administrator who helped write the report. "But no one wants to say that out loud. "I'm not saying that individuals in the system are racist, but that it's the history of health care policies like the difference in payments made by Medicare and Medicaid for the same treatment." she said. "And we need to eliminate those policies."

Golub was referring to policies in the health care system that send people seeking treatment to different services according to how they pay for their health care. If a person's health care is paid for by Medicaid, or if he or she is uninsured, he or she usually receives care in outpatient clinics within hospitals. On the other hand, people with
Medicare or private health insurance are generally referred to private doctors with practices in hospitals.

"People of color make up the majority of those who receive Medicaid and who are uninsured in New York City," Golub said. "If you have private health insurance, you will get an appointment in what essentially is a private physician's office even if it's in a hospital setting," she said. "But if you pay with Medicaid or you have no insurance, they will make you an appointment in an outpatient clinic."

Treatment in the clinics is of lower quality, she said, because those clinics are usually staffed by physicians in training who are not board certified. Further, when patients return for follow-up care, they generally see different physicians who do not not know them, and so their treatment does not progress same way it would if they were being cared for by the same doctor each time they came in."

The New York State Patient Bill of Rights expressly prohibits discrimination in hospitals based on source of payment. But the state needs to enforce that policy, Golub said.
"One of the things we are demanding is that the state actually enforce its own policies," she said.

For South Bronx residents, the differences effectively mean they get sick more often and die sooner. Death rates from all causes are 50 percent higher in the South Bronx than for all New Yorkers, the report noted. Death rates from AIDS are three-and-a-half times higher in the South Bronx than in New York City as a whole.