Persistent inequalities in health and access to health services: Evidence from New York City.
In Manhattan, the rate of hospital discharges for avoidable hospital conditions (AHC), a measure of access to timely and effective ambulatory care, fell by nearly 50 percent between 1999 and 2013. Despite this remarkable improvement, there has been virtually no change in racial, ethnic, or neighborhood-level differences in rates of AHC. This is surprising given New York City's emphasis on public health and its efforts to reduce health and health-care inequalities. We discuss the policy implications of these findings and argue that growing income and wealth inequalities have limited the ability of New York City to address inequalities in population health and health-care access. Unless there are substantial changes in federal and state policy, designed to reduce economic inequalities, it will be difficult to achieve the goal of eliminating health and health-care inequalities.