Could unifying outpatient practices help dismantle structural racism in health care

Health care segregation isn't just a relic of the past. In 2025, patients of color and those insured through Medicaid often receive care at different outpatient clinics than their white, commercially insured counterparts. This segregation isn't legally mandated - but it's structurally ingrained, and it has real consequences for health outcomes, medical education, and systemic equity.

A recent study published in JAMA Health Forum examined efforts by a large urban health system in New York to unify outpatient practices and suggests it may help dismantle some long-standing disparities. These findings can help journalists take a closer look at whether integrating care sites and eliminating distinctions based on insurance type can be a valuable tool in combating health care segregation.

Health care segregation in context

The roots of health care segregation run deep. Redlining and neighborhood disinvestment concentrated communities of color into areas with fewer resources, including underfunded hospitals and clinics. Research has shown that these structural inequalities continue to shape health care access for adults and children. Studies on Medicaid reimbursement disparities underscore why segregated care persists: providers are financially disincentivized from treating Medicaid patients. A 2021 report by the Robert Wood Johnson Foundation found that racial and ethnic minorities are disproportionately enrolled in Medicaid, which often has lower reimbursement rates than commercial insurance. This can lead to a two-tiered system where patients with Medicaid receive less comprehensive or timely care.

Practice unification: A possible solution?

Practice unification refers to efforts to eliminate segregation by combining multiple care sites into single care sites that do not differentiate between patients by insurance type

According to the study, some of the benefits of unifying outpatient practices - as reported by clinical, administrative, and health system leaders - include financial incentives, such as those related to the 340B drug pricing program and New York State's Article 28 accreditation, relocation to new facility spaces, and advocacy from leaders and trainees. Barriers include financial concerns, space constraints, and resistance from physicians and staff. The study also found that even after unification, some practices maintained dimensions of segregation based on practitioner, payer or scheduling.

Why this matters

The study's findings aren't just theoretical; they reveal the lived reality of millions of patients who navigate an inequitable health care system. Segregated outpatient care isn't just about location - it's about differences in provider quality, access to specialists, and even the time patients spend in waiting rooms.

How journalists can cover this issue

Structural racism in health care isn't new. Reporting could connect present-day disparities to their historical roots, helping audiences understand why these inequities persist and what can be done to dismantle them. Although the study focused on one New York-based health system, similar trends exist nationwide. Consider looking into whether outpatient segregation exists in their communities and what efforts-if any-are being made to unify practices.

Financial policies play a significant role in clinic unification. Consider tracking how state policies, federal reimbursement rates, and hospital financial incentives impact efforts to integrate outpatient care.

While the study primarily focused on administrators and clinicians, the patient perspective is crucial. How do patients experience segregation in outpatient care? Are they aware of the differences in quality and access between segregated and unified clinics?

Some hospitals may claim to have unified practices, but the reality might be more complicated and offer up some questions to consider asking: Are patients still being separated based on insurance type? Are some practitioners only seeing Medicaid patients while others exclusively treat people who are commercially insured?

As more health systems grapple with equity-driven reforms, news coverage on this issue will play a key role in ensuring transparency and accountability. Outpatient unification efforts offer a path forward, but they also illustrate how deeply embedded health care segregation remains. The question now isn't just whether hospitals will unify their practices - it's whether they'll do so in a way that eliminates disparities rather than just shifting them to new forms.

Additional resources

• The Commonwealth Fund: This organization publishes numerous reports and articles on health care disparities and potential solutions.
• Kaiser Family Foundation: KFF provides data and analysis on health care access, affordability, and quality, with a focus on vulnerable populations.
• National Academy of Medicine: NAM conducts research and provides guidance on issues related to health equity and structural racism in health care.
• Robert Wood Johnson Foundation: RWJF supports research and initiatives aimed at building a Culture of Health and advancing health equity.