Advancing urban health equity in the United States in an age of health care gentrifcation : a framework and research agenda

Abstract

Altres ajuts: Juan de la Cierva (JC-2018- 035322-I)

Unidad de excelencia María de Maeztu CEX2019-000940-M

Background: Access to health care has traditionally been conceptualized as a function of patient socio-demographic characteristics (i.e., age, race/ethnicity, education, health insurance status, etc.) and/or the system itself (i.e., payment structures, facility locations, etc.). However, these frameworks typically do not take into account the broader,dynamic context in which individuals live and in which health care systems function. Purpose: The growth in market-driven health care in the U.S. alongside policies aimed at improving health care delivery and quality have spurred health system mergers and consolidations, a shift toward outpatient care, an increase in for-proft care, and the closure of less proftable facilities. These shifts in the type, location and delivery of health care services may provide increased access for some urban residents while excluding others, a phenomenon we term "health care gentrifcation." In this commentary, we frame access to health care in the United States in the context of neighborhood gentrifcation and a concurrent process of changes to the health care system itself. Conclusions: We describe the concept of health care gentrifcation, and the complex ways in which both neighborhood gentrifcation and health care gentrifcation may lead to inequitable access to health care. We then present a framework for understanding health care gentrifcation as a function of dynamic and multi-level systems, and propose ways to build on existing models of health care access and social determinants of health to more efectively measure and address this phenomenon. Finally, we describe potential strategies applied researchers might investigate that could prevent or remediate the efects of health care gentrifcation in the United States.