May 24, 2021

Is there hospital segregation in Asian American communities?

To what extent are hospitals serving patients from Asian American communities? The Lown Institute Hospitals Index racial inclusivity metric can help answer this question.

By Emily Acker

Key Takeaways

  • The Lown Institute Hospitals Index includes a unique measure of inclusivity by patient income, education, and race. Racial inclusivity compares the racial mix in the community to that of Medicare patients receiving care at the hospital.
  • The Lown Institute identified six hospitals where the proportion of Asian American patients served is significantly higher than the proportion of Asian Americans in their community, and 11 hospitals whose patient population had significantly fewer Asian Americans than the surrounding community.
  • Several cities on the west coast, including Los Angeles and San Francisco, have some of the most and least inclusive hospitals for Asian Americans.

The Lown Institute Hospitals Index is the first hospital ranking to include a measure of racial inclusivity -- how well hospitals are serving people of color in their community. The Institute’s analysis finds that in many cities, hospitals are segregated by race, with some hospitals (often safety nets) that serve more patients from communities of color and other hospitals that serve whiter and wealthier communities. 

Racial segregation impacts many racial and ethnic minority groups, including Asian Americans, yet Asian Americans aren’t always included in conversations about racism. In this insight, we dive into the data to find out whether hospital segregation affects Asian American communities in the same way it does other communities of color. 

Patterns of hospital segregation 

The Lown Institute data allows us to compare the proportion of Asian Americans in hospitals’ catchment areas compared to the proportion of Asian Americans in hospitals’ actual patient populations. We found that six hospitals in the US serve at least 10% more Asian Americans than the percentage living in the surrounding community. For comparison, there are 182 hospitals that serve white Americans at this rate or higher, 86 hospitals that serve Black Americans at this rate or higher, and 33 that serve Hispanic or Latinx Americans at this rate or higher. 

Table 1 shows the hospitals that serve at least 10% more Asian Americans than the percentage of those living in the surrounding community. 

Table 1. Top hospitals, Inclusivity of Asian American Patients

Hospital Name Location % Asian American in hospital population  Difference between Hospital and Community Asian Population 
Garfield Medical Center Monterey Park, CA 55.5% 18.7%
San Gabriel Valley Medical Center San Gabriel, CA 52.6% 17.9%
Chinese Hospital San Francisco, CA 56.6% 15.4%
Alhambra Hospital Medical Center Alhambra, CA 50.8% 11.3%
Good Samaritan Hospital Los Angeles, CA 38.0% 11.2%
Flushing Hospital Medical Center Flushing, NY 28.3% 10.2%

We also found 11 hospitals that underserved Asian Americans at a rate of 10% or more, located in many of the same regions as the hospitals that served disproportionately more Asian Americans. Among the six hospitals that serve the highest proportion of Asian Americans, five are in the same city as a hospital that serves one of the lowest proportions of Asian Americans relative to the community. 

Some of the most and least racially inclusive hospitals are just a few miles from each other."

This pattern is all too common; some of the most racially inclusive hospitals are just a few miles away from hospitals that rank among the least racially inclusive. 

San Francisco: A tale of two hospitals

California is home to 38 of the top 50 hospitals that serve the highest percentage of Asian Americans nationwide. This is not surprising, as there is a long history of Asian communities in California that began with the Gold Rush in the 1850s. Currently, almost half of the Asians in the US live in the west. Historically, prejudice and segregation, through anti-immigration policies and land-ownership requirements, have had an impact on Asian communities’ ability to thrive. 

In areas where there are large Asian communities, such as in many cities in California, the story of segregation continues. Certain hospitals serve these communities at higher rates than expected and some hospitals serve them at lower rates than expected. Unfortunately, the available data, collected through the US Census, combines large, diverse groups of people into single categories. For example, people of Chinese, Thai, Indian, and Japanese descent  are all grouped together as Asians. In reality, however, we acknowledge that the countries are not the same and people’s experiences in the US healthcare system and health disparities are diverse. While this is a limitation of the data, we can give a few examples to showcase the overall phenomena of racial inclusivity among Asian Americans at two San Francisco hospitals: Chinese Hospital and California Pacific Medical Center - Davies Campus Hospital. 

Chinese Hospital, located in San Francisco’s Chinatown, ranks 42nd overall in the latest Lown Institute Inclusivity rankings, and 82nd on racial inclusivity specifically. Chinese Hospital has a long history of serving the Asian community in San Francisco. Chinese Americans living in San Francisco in the late 1800s were blamed for the spread of disease, were forbidden from leaving the immediate neighborhood, and were denied access to healthcare services. In 1900, Tung Wah Dispensary -- the establishment that would later become Chinese Hospital -- opened to provide free and low-cost care to the residents of San Francisco’s Chinatown. Chinese Hospital has survived earthquakes, fires, recessions, and ongoing anti-Chinese sentiment over the past 120 years and continues its mission to provide care to the Asian community. 

Chinese Hospital scores well in inclusivity and equity, which are deeply ingrained in its stated mission. Three miles away, Davies Campus Hospital ranks 2984th in overall inclusivity and 2246th in racial inclusivity out of 3548 total hospitals.  This hospital serves 6% fewer Asian Americans than the percentage who live in the community. Its patient population is more educated, has a higher average income, and serves fewer people of color than the population in its surrounding community, putting it in the bottom 20% of all hospitals for inclusivity. 

The impact of COVID-19

In the past year, some of the health disparities that Asian American communities face have been exacerbated by the COVID-19 pandemic. Recent analyses by the Kaiser Family Foundation (KFF) show that Asian Americans have a 57% higher risk of hospitalization and 49% higher risk of death from COVID-19 than white Americans.

"Asian Americans have a 57% higher risk of hospitalization and 49% higher risk of death from COVID-19 than white Americans.""

Additionally, among the racial/ethnic groups studied in the KFF analysis, Asian Americans had a lower rate for COVID-19 testing, but a much higher positivity rate than white Americans. Barriers to accessing healthcare and testing services, as well as increased rates of racial attacks may be partly to blame for the increased COVID-19 burden on Asian communities. Chinese Hospital, and other similar community hospitals, have been working to reduce these barriers to care by increasing community testing initiatives and vaccination clinics

The COVID-19 pandemic highlights the need for increased access to care for communities of color. Reducing hospital segregation -- ensuring that people are welcome and can be treated at their local hospital -- may be one tool to help reduce overall health disparities among communities of color.