Health Care in World Cities: New York, Paris, and London

Preface

vii Preface New York, Paris, and London are among the largest cities in some of the wealthiest nations of the world. They are strategic locations for transnational corporations, as well as for governments and international organizations .Although they consider themselves unique, these cities share many characteristics and problems.As centers for specialized financial and legal services, media, and culture, they exercise a powerful influence, not only on their own nations, but also on the rest of the world. Their inhabitants are heterogeneous, including some of the wealthiest and poorest members of their respective nations, and they attract the “creative classes” (Florida, 2005) that contribute to innovation and economic growth. Aside from serving as vast engines of economic growth, world cities are characterized by large and growing disparities in wealth, income, housing, and health. They provide relatively high levels of public services and public transportation, and they attract people from their extensive metropolitan regions—indeed, from around the world—to their universities , museums, theaters, and libraries. As centers for biomedical research and specialized medical care, these cities also provide access to state-ofthe -art health services. Many of their hospitals serve as national, even global, centers of excellence, attracting patients worldwide; such hospitals include the Memorial Sloan-Kettering Cancer Center and New York– Presbyterian Medical Center in Manhattan, Hôpital Saint Louis or Hôpital Européen-Georges Pompidou in Paris, and Guy’s and St. Thomas’s hospitals in London. Alongside such venerable institutions are equally well-known hospitals and health centers that serve the most disadvantaged populations. In New York, a vast network of public hospitals and health centers serves as a safety net for those without health insurance and for a significant share of the Medicaid population. In Paris and London, with their systems of universal coverage, there is not a formal viii Preface safety net system separate from the public institutions, but special initiatives are targeted to serve the needs of the most vulnerable populations. Chapter 1 sets the context for our analysis of health system performance by reviewing the literature that compares the health care systems and population health of cities and by presenting a new approach to comparing the health care systems of New York, Paris, and London. Chapter 2 provides an overview of the broader health system context of each nation and the salient features of the health systems and public health infrastructure in each city. We then present the rationale for our systematic comparisons across and within our three cities. Chapters 3, 4, and 5 analyze several dimensions of access to health care based on three indicators: “avoidable mortality,” avoidable hospital conditions, and revascularization (coronary artery bypass surgery and angioplasty) adjusted for the burden of disease. Each of these chapters explores aggregate measures of access and disparities within each city and what we define in Chapter 2 as their “urban cores”: Manhattan, Paris, and Inner London. (When we refer to policies, practices, and/or empirical findings that apply to the entire city, we refer to New York City and London. When we refer to our empirical findings for the urban cores, we refer to Manhattan and Inner London. For Paris, there is no distinction between the city and the urban core. As we explain in Chapter 2, for Paris, the equivalent of New York City and Greater London is Paris and its three surrounding departments.) The final chapter summarizes the most striking similarities and differences among the health care systems of New York, Paris, and London; reflects on the value of our approach to comparative health systems analysis ; and speculates on the lessons drawn from our findings. Our city-level comparisons produce some evidence that reinforces wellknown critiques of our health care system and other evidence that questions the conventional wisdom on health system performance and access to care across these systems. For example, a recent comparison of England and the United States indicates that the English have better health status than Americans (Banks et al., 2006). This has led some journalists to suggest that the National Health Service (NHS) provides better access to health care than the U.S. system.* Our empirical analysis, however, reveals a * In fairness, the authors of the study do not make this claim or support this view— but that has not prevented some members of the media from making this claim. Preface ix more complex reality. In Chapter 3, our examination of avoidable mortality indicates...