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Access to outpatient care in Manhattan and Paris: A tale of real change in two world cities

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  • Gusmano, Michael K.
  • Weisz, Daniel
  • Mercier, Grégoire
  • Vasile, Maria
  • Rodwin, Victor G.

Abstract

France's system of universal health insurance (UHI) offers more equitable access to outpatient care than the patchwork system in the U.S., which does not have a UHI system. We investigate the degree to which the implementation of the Patient Protection and Affordable Care Act (ACA) has narrowed the gap in access to outpatient care between France and the U.S. To do so, we update a previous comparison of access to outpatient care in Manhattan and Paris as measured by age-adjusted rates of hospital discharge for avoidable hospital conditions (AHCs). We compare these rates immediately before and after the implementation of the ACA in 2014. We find that AHC rates in Manhattan declined by about 25% and are now lower than those in Paris. Despite evidence that access to outpatient care in Manhattan has improved, Manhattanites continue to experience greater residence-based neighborhood inequalities in AHC rates than Parisians. In Paris, there was a 3% increase in AHC rates and neighborhood-level inequalities increased significantly. Our analysis highlights the persistence of access barriers to outpatient care in Manhattan, particularly among racial and ethnic minorities, even following the expansion of health insurance coverage.

Suggested Citation

  • Gusmano, Michael K. & Weisz, Daniel & Mercier, Grégoire & Vasile, Maria & Rodwin, Victor G., 2023. "Access to outpatient care in Manhattan and Paris: A tale of real change in two world cities," Health Policy, Elsevier, vol. 132(C).
    • Handle: RePEc:eee:hepoli:v:132:y:2023:i:c:s0168851023001070
    DOI: 10.1016/j.healthpol.2023.104822
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    References listed on IDEAS

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    1. Scott, Allen J. (ed.), 2001. "Global City-Regions: Trends, Theory, Policy," OUP Catalogue, Oxford University Press, number 9780198297994.
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    3. Dieu Thanh Le & Hail Park, 2020. "The Impact Of Demographic Change On Economic Growth," The Singapore Economic Review (SER), World Scientific Publishing Co. Pte. Ltd., vol. 65(02), pages 471-484, March.
    4. Daniel Weisz & Michael K. Gusmano & Caroline Laborde & Valerie Feron & Victor G. Rodwin, 2022. "The evolution of infant mortality and neighbourhood inequalities in four world cities: 1988–2016," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(3), pages 1545-1554, May.
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