Special Series: Places of Healthcare Receipt Among New Yorkers with High Healthcare Need Over the Course of the Pandemic 

Executive Summary

New York City’s high-need residents — those managing multiple chronic conditions, work-limiting health problems, or serious psychological distress — experienced a growing divide in *where* and *how* they could access care as the pandemic wore on, with economically disadvantaged New Yorkers increasingly falling back on reactive, costly care settings. New Poverty Tracker research from Columbia University, supported by Robin Hood and The Leona M. and Harry B. Helmsley Charitable Trust, tracked these New Yorkers from 2021 to 2022 and found that as more-advantaged residents returned to pre-pandemic patterns of primary care, disadvantaged New Yorkers remained stuck relying on emergency rooms, urgent care centers, and appointment systems that were increasingly difficult to navigate.

Key Findings

Primary care access diverged: Utilization of doctors’ offices and health centers rose to 93% among more-advantaged, high-need New Yorkers in 2022 (up from 86% in 2021), while it held flat at 78% for economically disadvantaged New Yorkers across both years — doubling the gap in primary care access.

Reliance on emergency and urgent care persisted for the disadvantaged: Economically disadvantaged, high-need New Yorkers continued to rely more heavily on emergency rooms (29%) and urgent care centers (50%) than their more-advantaged counterparts (11% and 44%, respectively) in 2022.

Making an appointment got harder, not easier, for disadvantaged New Yorkers: Just 59% of economically disadvantaged New Yorkers found it easy to make healthcare appointments in 2022, down from 67% in 2021 — even as more-advantaged New Yorkers found it easier (68%, up from 62%).

Transportation remained a bigger barrier for the disadvantaged: Although difficulty getting to appointments declined overall, economically disadvantaged New Yorkers were far more likely to cite transportation-related barriers than their more-advantaged peers (11% versus 4% in 2022).

Clinical interactions improved, but so did reported discrimination: Regardless of economic status, high-need New Yorkers reported more positive interactions with providers in 2022 than in 2021 — including that providers were more likely to listen to their concerns (80% among the disadvantaged, up from 72%; 79% among the more-advantaged, up from 65%). Even so, 14% of economically disadvantaged, high-need New Yorkers avoided seeking care in 2022 out of fear of discrimination or disrespect, up from 10% in 2021 — nearly three times the rate reported by more-advantaged New Yorkers (5%, down from 7%).

As more-advantaged New Yorkers largely returned to normal patterns of healthcare access, economically disadvantaged, high-need New Yorkers continued to navigate a fragmented system defined by longer waits, harder-to-reach appointments, and rising experiences of discrimination — pointing to structural inequities that predate the pandemic and have only grown more entrenched since.