New York has gotten quite a bit of attention lately in the #Coronavirus coverage because, apparently, the city’s percentage of younger patients being hospitalized with #Covid19 is higher than reported in any of the over 200 countries with confirmed cases. ICU admissions and fatalities among the younger demographic, however, are more or less consistent with international pattenrs.
So, why are so many more younger patients being hospitalized in New York? Does the virus just behave differently in the Big Apple for some unknown reason? When illogical things happen, you have to try to find logical explanations, so let me suggest a fairly straightforward possibility.
New York hospitals need money. The ones that don’t need money, want money. Last year, New York hospital executives received $80 million in bonuses; that takes quite a bite out of the budget.
One Brooklyn hospital that was highlighted in the media, Brookdale, is what is referred to as a “safety net hospital”, meaning at least 30% of inpatient care is paid for by Medicaid (the government’s healthcare program for the poor).
One in five New Yorkers are enrolled in Medicaid and, according to a report in the Daily Mail, “A stark New York City map has revealed that there are higher numbers of cases of coronavirus in poorer neighbourhoods than in wealthier zip codes”. So, it appears that the segment of the population whose medical care is subsidized by Medicaid, which is to say, whose hospital bills are 100% covered by the government, require hospitalization more than other people.
Now, the hospitals in these neighbourhoods, like Brookdale, have faced, and are actually facing right now, funding cuts. When their bills will be paid by the state, hospitalizing patients who may not actually require inpatient care, can be a significant source of revenue for a hospital grappling with budget cuts. Medicaid incentivizes them to admit patients into the facility even when they may be perfectly safe to recover at home. Bear in mind that Medicaid fraud in New York is estimated to amount to around $18 billion per year, and the bulk of that is fraud by providers, not recipients.
Hospitals like Brookdale have to offset budget cuts however they can. Here it is worth noting that if the healthcare system is overwhelmed during the Covid-19 pandemic, it has less to do with the pandemic and more to do with the Neoliberal de-funding of health services over the past several years. But yes, more Medicaid money is paid out in New York than in any other state, Covid-19 testing and treatment is covered by Medicaid, and the eligibility requirements for enrolment in Medicaid have been eased in response to the pandemic. So, expensive treatments for low-income patients will be guaranteed, and these patients will mostly be seeking care from neighbourhood hospitals that are struggling to survive financially
Now, it goes without saying that I am not suggesting there are no legitimate hospitalizations of younger people infected with the virus; but I believe the percentage of necessary hospitalizations of younger patients is probably actually in line with global patterns, and the incentive to hospitalize Medicaid recipients accounts for the uniquely higher percentage in New York.