The most inclusive hospitals receive the least amount of funding

The most inclusive hospitals receive the least amount of funding, according to a study published in Radiology.

Researchers from Drexel University College of Medicine, Boston Medical Center, Denver Health and other academic centers explored the relationship between hospitals that ranked high on the Lown Index for inclusivity and community benefit and the amount of funding they received from the National Institute of Health (NIH) from 2017-2021. 

The Lown Institute ranks hospitals with a grade of A to D. They define inclusivity as “the extent to which patients being served are demographically similar to those in the surrounding community,” and community benefit as “the extent of hospital investment in community health.

Relationship between hospital inclusivity and funding

Of 75 hospitals in the study, researchers discovered an inverse correlation between NIH funding and inclusivity. In other words, more inclusive hospitals – that serve lower-income patients, patients with lower levels of education and patients of color – received the lowest amount of funding. 

• Of the hospitals that received the lowest grade for inclusivity (D), 67% received the highest amount of funding (over $44 million) 
• Of the hospitals that received the lowest amount of funding from the NIH, the majority (59%) ranked A for inclusivity

The study also showed disparity in the distribution of radiology funding across hospitals. The hospitals that received the highest funding (20%) secured around two-thirds (66%) of the total NIH funds allocated between 2017 and 2021. 

When it comes to the relationship between community benefit ranking and government funding, the majority of hospitals that ranked highest for community benefit (43%) received the lowest amount of funding. However, the study ultimately concluded there was no statistical significance between community benefit ranking and government funding. 

“The negative correlation between NIH funding and ranking for inclusivity metrics is in some ways not surprising,” wrote Tejas S. Mehta, MD MPH and Max P. Rosen, MD, MPH in their commentary on the study. “Institutions that are awarded funding from the NIH are more likely to be large academic medical centers. At these well-resourced institutions, a patient’s lack of health insurance, limited access to transportation, and limited health literacy are barriers to care in under-resourced communities.” 

Mehta and Rosen suggest that partnerships between academic institutions and safety-net hospitals is key to bridging health equity gaps. 

Partnerships between high-funded and safety-net hospitals can increase diversity in clinical trials, which will create better health outcomes and more reliable data for all. 

“The goals of increasing diversity in clinical trial participation include providing opportunities for all potential participants and their communities, generating accurate knowledge of the treatment being studied including detecting potential heterogeneous outcomes and effects, and building trust of the institutions and in medical research.”