Health Equity Impact Assessment Needed

COVID-19 and other market factors are resulting in shifts in Minnesota’s health care landscape. The pandemic has shined a light on the flaws in our fee-for-service-based health care system and the impact on primary care. Despite needing a robust system now more than ever, the future is unclear.

Concerning Shifts in Health Care

  • Closures of urban safety-net hospitals have been shown to disproportionately affect minority, elderly and uninsured populations as well as increase stress and decrease access to primary care providers (Annals of Family Medicine, U.S. News & World Report).
  • Current health care payment and insurance models frequently reimburse at lower rates for many services that are essential for rural communities and are provided at rural hospitals, including obstetrical care, mental health, substance use treatment and emergency and trauma services. There are strong financial disincentives for systems to maintain rural hospitals and provide these important services (Improving Access to Maternal Health in Rural Communities). 
  • Primary care continues to be under-valued and under-resourced, even though it is the frontline of health care—often the first point of contact for patients within the health care system (Health Affairs). Primary care physicians provide vital services, including managing complex, chronic conditions; caring for acute illness; keeping people healthy through preventive medicine and providing much needed continuity care. Greater primary care investment translates to lower costs, higher patient satisfaction, fewer hospitalizations and ER visits and lower mortality (Primary Care Investment). Yet, our current system rewards provision of more services vs. efforts to prevent patients from getting sick in the first place—undervaluing management of chronic conditions, prevention and wellness care.

As shifts continue to happen in our health care landscape, it’s imperative that these changes do not further exacerbate Minnesota’s unacceptable health disparities and lessen the availability of essential access to primary care services.

Communities who are disproportionately impacted by health disparities should be an important consideration in changes hospitals and clinics make to where and how they deliver care. The Minnesota Academy of Family Physicians encourages the use of a health equity impact assessment to best understand those ramifications. We ask M Health Fairview and Allina Health to complete health equity impact assessments for the communities served by St. Joseph’s Hospital and United Family Medicine in St. Paul before proceeding with changes and make their findings available for public feedback.

We owe it to our most vulnerable communities to make these decisions in a transparent manner, weighing their impact on more than just the financial bottom line.


In June 2020, the MAFP House of Delegates passed a resolution to advocate for the completion of health equity impact assessments prior to the closure of hospitals, clinics or service lines within a health system. Read the resolution.

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