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Comprehensive Hospital Statistics in New York, USA

March 13, 2026

New York State operates one of the largest and most complex hospital systems in the United States, with 266 active hospitals, more than 55,000 staffed beds, and over 2.1 million inpatient discharges annually. Despite spending per capita on hospital care that runs 43% above the national average, the state consistently ranks near the bottom of national hospital quality ratings — 48th out of 50 states in 2025 — and achieves only average health outcomes. This paradox of high expenditure and mediocre performance is a central theme running through the data presented in this report.

The statistics compiled here draw on multiple datasets and analytical reports covering hospital infrastructure, patient utilization, quality, primary care capacity, and health equity. Together they span the years 2013 through 2025 and provide a comprehensive overview of the structure and performance of the state’s hospital system.

The report is organized into six sections that build from the structural to the systemic. It begins with the physical and financial foundation of the hospital system, moves through patient volume and disease patterns, examines quality and safety outcomes, explores primary care capacity and investment, and concludes with a close analysis of racial and geographic health disparities. A methodological appendix describes the two core hospital data systems that underpin the majority of statistics cited.

Hospital Infrastructure

This section covers the structural foundation of New York’s hospital system: the number and type of hospitals, their physical capacity, and the revenue they generate. New York ranks 6th among all states in total hospital count, and its system is dominated by non-profit facilities — a defining characteristic that shapes both governance and funding.

Number of Hospitals and Ownership Type (2020–2024)

Definitive Healthcare tracks 266 active hospitals in New York, representing 3.6% of more than 7,300 hospitals tracked nationally. New York has no for-profit hospitals. The table below shows annual hospital counts by ownership type. Nationally, there were 5,112 community hospitals in 2023, the majority of which were non-profits.

Year	State/Local Gov’t	Non-Profit	Total
2024	22	136	158
2023	22	136	158
2022	23	137	160
2021	23	138	161
2020	25	137	162

The total number of hospitals declined from 162 in 2020 to 158 by 2023–2024, driven by a reduction in state/local government hospitals (from 25 to 22). Non-profit hospitals held steady at 136–138 facilities throughout this period. New York has maintained zero for-profit hospitals across all five years.

Hospital Admissions per 1,000 Population by Ownership Type (2020–2024)

Admissions per 1,000 population reflect overall demand for inpatient care across the state’s ownership segments. For-profit admissions are not applicable given the absence of for-profit hospitals in New York.

Year	State/Local Gov’t	Non-Profit	For-Profit	Total
2024	17	93	N/A	109
2023	16	90	N/A	106
2022	16	87	N/A	103
2021	16	87	N/A	103
2020	16	82	N/A	98

Total admissions per 1,000 population rose from 98 in 2020 to 109 in 2024 — an 11% increase over four years. Growth was concentrated in non-profit hospitals, which added 11 admissions per 1,000 population (82 → 93). State/local government hospitals remained stable at 16–17 throughout.

Statewide Aggregate Inpatient Volume

The following key figures are drawn from the Individual Hospital Statistics dataset aggregating all reporting New York hospitals. They represent gross system-wide totals across all facility types.

Total staffed beds: 55,228
Total patient discharges: 2,130,574
Total patient days: 12,348,888
Total gross patient revenue: $403.1 billion

These figures reflect gross billed charges before payer adjustments. New York’s 2+ million annual discharges and $403 billion in gross patient revenue place it among the largest and most resource-intensive state hospital systems in the nation.

Largest Hospitals by Gross Patient Revenue and Capacity

Collectively, the top 25 hospitals in New York State account for more than $62 billion in net patient revenue. The table below draws on both Definitive Healthcare net revenue rankings and SPARCS individual hospital data, showing staffed beds, total discharges, patient days, and gross patient revenue for the highest-volume institutions. Of the top 25 by net revenue, 56% are located in New York City’s five boroughs.

Hospital	City	Beds	Discharges	Patient Days	Gross Revenue
Tisch Hospital	New York	1,766	110,329	540,025	$45.1B
NY Presbyterian / Weill Cornell Med. Ctr.	New York	3,286	139,420	938,992	$38.6B
Montefiore Einstein Hospital, Moses Campus	Bronx	1,521	75,053	474,178	$20.4B
Long Island Jewish Medical Center	New Hyde Park	1,486	75,340	385,704	$15.3B
Memorial Sloan Kettering Cancer Center	New York	514	25,648	179,768	$15.0B
The Mount Sinai Hospital	New York	1,142	57,509	392,270	$14.3B
Westchester Medical Center	Valhalla	888	29,585	221,373	$11.6B
North Shore University Hospital	Manhasset	1,071	48,845	290,624	$11.4B
Strong Memorial Hospital	Rochester	873	37,199	305,227	$9.5B
Stony Brook University Hospital	Stony Brook	788	37,659	227,773	$8.7B
NYU Langone Hospital – Long Island	Mineola	511	35,113	172,926	$8.9B
Upstate University Hospital	Syracuse	781	29,162	170,420	$7.1B
Buffalo General Medical Center	Buffalo	1,068	47,321	287,974	$5.0B
Catholic Health Saint Francis Hospital & Heart Ctr.	Roslyn	326	20,242	102,182	$4.6B
NYC Health + Hospitals / Bellevue	New York	898	24,404	190,911	$3.5B

Tisch Hospital and NewYork-Presbyterian / Weill Cornell lead in gross revenue and total discharges. Specialty facilities such as Memorial Sloan Kettering (514 beds, $15.0B gross) generate high revenues relative to their physical size. The NYC Health + Hospitals system, which handles a disproportionate share of low-income and uninsured patients, shows lower gross revenues relative to bed count.

Specialist and Rehabilitation Facilities

SPARCS identifies the following ten Article 28–certified facilities whose discharges are primarily rehabilitation or life-support-related rather than acute inpatient care. They are included in the SPARCS dataset but their discharge statistics, length-of-stay figures, and cost-per-case metrics are not directly comparable to those of general acute care hospitals.

000340: United Memorial Medical Center Bank Street Campus
000775: Helen Hayes Hospital
000831: Sunnyview Hospital and Rehabilitation Center
000968: Garnet Health Medical Center – Catskills – G. Hermann Site
001046: Winifred Masterson Burke Rehabilitation Hospital
001138: Blythedale Children’s Hospital
001460: New York Eye and Ear Infirmary of Mount Sinai
001486: Henry J. Carter Specialty Hospital
009431: St. Peter’s Addiction Recovery Center
010223: Calvary Hospital

These ten facilities are Article 28–certified but primarily serve rehabilitation or long-term care populations. Their outcomes data should be interpreted separately from general acute care hospital benchmarks.

Patient Volume and Utilization

This section examines who uses New York’s hospitals, in what volumes, and for what reasons — drawing on SPARCS data across multiple years, as well as the 2013 pediatric care report and the 2014 spatio-temporal disease analysis.

SPARCS Patient Demographics vs. State Census (2014)

The 2014 SPARCS dataset covered 19.8 million New Yorkers. It recorded 2,298,756 inpatient stays, 7,356,608 emergency department visits, 2,443,416 ambulatory surgery cases, and 11,033,814 outpatient visits. The table below compares the demographic composition of patients across each care setting with the state census baseline.

Demographic	Census	Inpatient	ED Visits	Amb. Surgery	Outpatient
Age: Under 5 years	6.0%	12.5%	8.6%	1.8%	5.1%
Age: Under 18 years	21.3%	15.4%	20.2%	5.3%	13.3%
Age: 65+ years	15.0%	34.2%	13.9%	32.5%	24.5%
Sex: Female	51.4%	56.2%	55.1%	55.9%	59.2%
Race: White alone	70.1%	57.4%	47.1%	65.8%	37.0%
Race: African American	17.6%	18.5%	25.5%	10.6%	23.8%
Race: Asian alone	8.8%	3.8%	2.5%	3.0%	3.4%
Race: Other / Unknown	—	19.6%	24.4%	19.7%	35.3%

Adults 65+ are heavily overrepresented in inpatient stays (34.2% vs. 15.0% census share) and ambulatory surgery (32.5%). African Americans are disproportionately represented in ED visits (25.5%) and outpatient visits (23.8%) relative to their 17.6% census share. White patients are underrepresented across all care settings. Children under 5 are concentrated in inpatient stays (12.5% vs. 6.0% census share).

Top Disease Categories by Discharge Volume (2014)

Using Clinical Classifications Software (CCS) groupings, the following were the highest-volume diagnoses for inpatient stays and emergency department visits in 2014. Moran’s I index measures spatial clustering tendency (1 = perfect clustering, 0 = random, −1 = dispersed); values marked * are significant at the 1% confidence interval, ** at 5%.

Top 10 Inpatient Discharge Diagnoses

The table ranks the ten most common inpatient diagnoses by discharge volume, alongside the mean discharge rate per 10,000 residents and the spatial autocorrelation score.

Diagnosis	Total Discharges	Rate per 10k (Mean)	Moran’s I Index
Liveborn	222,803	100	0.00
Osteoarthritis	54,367	44	0.46
Congestive heart failure (non-hypertensive)	45,722	25	0.64
Mood disorders	43,209	122	0.54
Other complications of birth / puerperium	36,480	15	0.70
Cardiac dysrhythmias	35,297	22	0.61
Complication of device, implant or graft	33,305	20	0.62
Diabetes mellitus with complications	33,040	15	0.70
Asthma	32,505	10	0.78
Acute myocardial infarction	31,249	22	0.53

Top 10 Emergency Department Visit Diagnoses

The table ranks the ten most common ED visit diagnoses by total visit volume. Spatial clustering is generally lower for ED diagnoses than for inpatient diagnoses, reflecting a more uniform geographic distribution of acute and emergency care needs.

Diagnosis	Total Visits	Rate per 10k (Mean)	Moran’s I
Abdominal pain	342,294	189	0.05
Nonspecific chest pain	300,623	197	0.02 (n.s.)
Asthma	158,175	52	0.04
Other non-traumatic joint disorders	137,937	58	0.25
Other complications of pregnancy	134,195	49	0.02
Other injuries / conditions, external causes	111,137	63	0.04
Other viral infections	109,746	35	0.38
Sprains and strains	109,429	81	0.02 (n.s.)
Superficial injury / contusion	102,582	79	0.03
Other gastrointestinal disorders	93,094	49	0.01 (n.s.)

Asthma is the most geographically clustered inpatient diagnosis (Moran’s I = 0.78), with significant high-high clusters near JFK airport and in upper Manhattan. Liveborn deliveries show zero clustering. Among ED diagnoses, other viral infections show the highest clustering (0.38). Most ED diagnoses have low spatial autocorrelation, suggesting broadly uniform distribution of emergency care needs across geographies.

Disease Temporal Trends (Inpatient, 2005–2014)

Analysis of 2005–2014 SPARCS data reveals the following temporal trends in inpatient discharge rates across New York State’s major disease categories.

Most major inpatient diseases showed a downward trend in discharge rates over the decade.
Notable exceptions with rising trends: osteoarthritis and congestive heart failure (non-hypertensive).
Asthma inpatient stay, ambulatory surgery, and outpatient visit rates all trended downward.
Asthma emergency department visit rates rose over the same period — diverging from the inpatient trend.
Among asthma subcategories, ‘asthma other than chronic obstructive asthma with acute exacerbation’ showed a rising inpatient trend.

The divergence between falling asthma inpatient rates and rising asthma ED rates may reflect a shift toward less-managed acute exacerbations rather than improved overall disease control. Rising trends for osteoarthritis and heart failure are consistent with an aging statewide population.

Pediatric Inpatient and Emergency Care (2013)

The 2013 SPARCS pediatric analysis covered all hospital inpatient discharges and emergency room visits for children under 18 in New York State. Newborns and newborn transfers were excluded from most analyses. The state population under 18 was approximately 4.5 million, of whom 42% lived in New York City.

Pediatric Inpatient Discharges — Key Metrics

The following list summarizes the headline statistics for non-newborn pediatric inpatient care across New York State hospitals in 2013.

Total discharges, children under 18: 362,360 — representing 15.0% of all NYS inpatient discharges
Of which: newborn deliveries: 233,371 (64.4%)
Excluding newborns: non-newborn pediatric discharges: 125,114 (5.2% of all NYS discharges)
Average length of stay — all pediatric: 4.4 days (vs. national average 4.2 days)
Average length of stay — surgical discharges: 5.5 days
Average length of stay — medical discharges: 4.2 days
Share with medical APR-DRG vs. surgical: Over 80% medical / under 20% surgical
Potentially preventable readmission (PPR) rate: 4.1 per 100 discharges (state all-age rate: 6.7)
Geographic distribution — NYC hospitals: 58.5% of all pediatric discharges
Geographic distribution — Long Island: 9.7%
Geographic distribution — Mid-Hudson: 9.6%
Primary payer — Medicaid (non-CHP): 61.0%
Primary payer — Private insurance: 31.1%
Primary payer — Child Health Plus (CHP): 2.0%

Most Common Pediatric Inpatient Diagnoses by Age Group

Diagnosis patterns vary markedly by age. The table maps the most common APR-DRG and surgical procedure for each pediatric age group in 2013.

Age Group	Most Common Diagnosis / Procedure
Under 28 days	Fever (87% admitted via ER); Pyloromyotomy (49.1% of surgical discharges in this group)
28 days – <1 year	Bronchiolitis and RSV pneumonia (most frequent); Pyloromyotomy (11.4% of surgical discharges)
1–4 years	Respiratory conditions; Tonsillectomy / adenoidectomy (most frequent surgical procedure)
5–9 years	Asthma; Laparoscopic appendectomy (20.2% of surgical discharges)
10–14 years	Appendectomy (most common overall); Bipolar disorders (most common for females); Laparoscopic appendectomy (23.2%)
15–17 years (M)	Bipolar disorders
15–17 years (F)	Vaginal delivery; Repair of obstetric laceration (14.4% of surgical discharges)

Pediatric Emergency Department Visits — Key Metrics

The following list summarizes the headline statistics for pediatric emergency department visits in New York State hospitals in 2013. These are treat-and-release visits only; ER visits resulting in admission are counted in the inpatient data above.

Total treat-and-release ER visits, under 18: 1,428,433 — representing 22.3% of all NYS treat-and-release ER visits
Share involving injury: 27.2%
Most common injury: falls: 32.1% of injury visits
Most common injury: struck by / against object: 21.8% of injury visits
Primary payer — Medicaid or Child Health Plus: ~63%
Primary payer — Private / commercial insurance: ~25%
Primary payer — Self-pay / uninsured: 8.0%
Share of ER visits resulting in inpatient admission: 5.4%
ER-to-admission rate, children under 28 days: 11.1%
ER-to-admission rate, ages 1–17: 4.2%–5.8%
Most common cause of ER-to-inpatient admission: Appendectomy (88.7% came through ER)
Peak ER visit times — weekdays: 10am–1pm and 4pm–9pm
Peak ER visit times — weekends: 11am–9pm
Most common ER diagnoses, under age 10: Respiratory infections (upper respiratory infections)
Most common ER diagnoses, over age 10: Injury-related; sprains and strains most frequent from age 10

New York City hospitals handled 59% of all pediatric inpatient care and ER visits despite housing only 42% of the state’s under-18 population. Medicaid dominates pediatric payer mix (61–63%). The high daytime ER visit rate on weekdays (10am–5pm) suggests a substantial volume of non-emergent visits that could be managed in primary care settings. Children under 28 days old have the highest ER-to-inpatient admission rate (11.1%), reflecting the clinical complexity of neonatal presentations.

Hospital Quality

This section covers two complementary dimensions of hospital quality: the federal CMS star ratings published in August 2025, which measure mortality, safety, readmissions, patient experience, and timeliness; and the New York Patient Occurrence Reporting and Tracking System (NYPORTS) 2023 adverse event data, which captures reported adverse occurrences across all certified health facilities.

CMS Hospital Quality Star Ratings (August 2025)

CMS rates hospitals on a 1–5 star scale. In August 2025, 132 New York hospitals received a rating. The statewide average was 2.53 out of 5, ranking New York 48th out of 50 states — a slight improvement from 49th in 2024 (average 2.4 stars). New York boasts the highest gross state product per capita in the U.S., and its per capita hospital expenditures were 43% above the national average as of 2020.

Lowest-Rated States — National Comparison

The table places New York in national context, showing the ten lowest-rated states alongside selected high-performing states and the national benchmark. States are ranked from lowest to highest average CMS rating.

State	Avg. Rating (out of 5)	Context
DC (District of Columbia)	2.29	Lowest in nation
NM (New Mexico)	2.45
MS (Mississippi)	2.49
NY (New York)	2.53	48th of 50 states; +0.13 from 2024
AL (Alabama)	2.57
AR (Arkansas)	2.63
WV (West Virginia)	2.63
United States (national avg.)	3.08	Benchmark
WI (Wisconsin)	3.77	Among highest
MN (Minnesota)	3.80	Among highest
SD (South Dakota)	4.08	Highest in nation
UT (Utah)	4.09	2nd highest

New York scores near the level of Mississippi and Alabama — among the country’s poorest states — despite spending far above the national average on hospital care. South Dakota (4.08) and Utah (4.09) lead the nation. This persistent gap between high spending and low quality ratings has existed for at least a decade.

Distribution of Star Ratings: New York vs. National Average

Beyond the average, the distribution of star ratings exposes a structural concentration of low-performing facilities in New York. The table compares the share of hospitals at each star level between New York and the national average.

Star Rating	New York (%)	National (%)	NY vs. National
⭐ One Star	22.0%	8.0%	+14.0 pp
⭐⭐ Two Stars	31.1%	22.7%	+8.4 pp
⭐⭐⭐ Three Stars	28.0%	32.6%	−4.6 pp
⭐⭐⭐⭐ Four Stars	9.8%	26.7%	−16.9 pp
⭐⭐⭐⭐⭐ Five Stars	9.1%	10.1%	−1.0 pp

More than half of New York hospitals (53.1%) receive one or two stars — nearly double the national share (30.7%). Only 9.8% receive four stars, vs. 26.7% nationally. Five-star performance is broadly comparable (9.1% NY vs. 10.1% national). The state’s weakness is concentrated in the middle tiers: too few three- and four-star facilities.

Average CMS Rating by Ownership Type (New York)

The following list summarizes average CMS star ratings broken down by hospital ownership type in New York State. Ratings are not adjusted for patient poverty levels or social risk factors.

Veterans’ hospitals (n = 8): 3.5 stars — highest of all ownership types
Not-for-profit hospitals: 2.6 stars
Government-owned hospitals: 1.7 stars
NYC Health + Hospitals facilities (n = 10, subset of government): 1.5 stars — lowest

Veterans’ hospitals outperform all other ownership types. The 10 NYC Health + Hospitals facilities — which serve a disproportionate share of low-income and uninsured patients — average just 1.5 stars. CMS ratings are not adjusted for poverty or social risk factors, which partially explains this result.

Average CMS Rating by New York Region

Hospital quality varies considerably across New York’s regions. The following list presents average CMS ratings for each regional grouping, from highest to lowest performing. The statewide average of 2.5 is shown for reference.

Long Island: 3.5 stars — highest region
Mid-Hudson: 2.9 stars
Capital Region: 2.6 stars
North Country: 2.5 stars
Western New York: 2.5 stars
Central New York: 2.4 stars
Southern Tier: 2.3 stars
New York City: 2.2 stars
Mohawk Valley: 1.8 stars — joint lowest
Finger Lakes: 1.8 stars — joint lowest
Statewide average: 2.5 stars

Long Island leads with 3.5 stars while the Finger Lakes and Mohawk Valley share the lowest regional average at 1.8 stars. New York City, despite hosting the state’s largest and highest-revenue hospitals, averages only 2.2 stars. The Commission on the Future of Health Care (chaired by Sherry Glied) has signaled that upcoming recommendations will address hospital quality and link state funding to quality performance.

Adverse Events — NYPORTS (2023)

The New York Patient Occurrence Reporting and Tracking System (NYPORTS) records mandatory adverse event reporting across all Article 28–certified facilities. In 2023, a total of 2,875 adverse events were reported statewide.

Hospital Adverse Event Rates by Region (2023)

The table presents hospital-only adverse occurrences, discharge volumes, and rates per 10,000 discharges by New York regional office, alongside ASC data where available. Rates reflect reported events and may be influenced by both patient acuity and institutional reporting practices.

Region	Hosp. Occ.	Hosp. Discharges	Hosp. Rate*	ASC Occ.	ASC Discharges
Capital District	290	289,144	10.0	21	117,939
Central New York	287	321,378	8.9	6	127,147
Metro – Long Island	273	589,625	4.6	25	189,264
Metro – New Rochelle	201	410,818	4.9	10	66,707
Metro – NYC	1,089	1,545,621	7.0	15	474,095
Western – Buffalo	135	295,803	4.6	8	123,440
Western – Rochester	301	272,377	11.1	2	71,585
Total	2,576	3,724,766	6.9 avg	87	1,170,077

* Adverse events per 10,000 hospital discharges.

Western Regional Office – Rochester has the highest adverse event rate (11.1 per 10,000 discharges), followed by Capital District (10.0). Metro NYC accounts for the largest absolute number of occurrences (1,089) but a comparatively moderate rate of 7.0. Long Island and Buffalo share the lowest rates at 4.6.

Adverse Events by Facility Type

The table shows the breakdown of adverse occurrences by facility type. Hospitals (including critical access and sole community hospitals) account for the large majority of events, reflecting both their higher volume of complex care and broader mandatory reporting scope.

Facility Type	Occurrences	% of Total	Rate per 10k Discharges
Critical Access Hospital	35	1.2%	—
Hospital	2,390	83.1%	—
Sole Community Hospital	151	5.3%	—
Hospital subtotal (all types)	2,576	89.6%	6.9
Ambulatory Surgery Centers (ASC)	87	3.0%	0.7 (per 10k of 1,170,077 discharges)
Diagnostic and Treatment Centers (D&TC)	212	7.4%	—
Total — all facility types	2,875	100%	—

Primary Care: Workforce, Access, and Investment

New York spends more than $300 billion annually on health care — among the highest in the nation — yet achieves only average health outcomes. Primary care, which handles one in every three health care visits statewide, receives just 3–5% of total health spending, well below the 10–12% recommended by national experts. The following data are drawn from the 2025 New York Health Foundation and Primary Care Development Corporation brief.

Primary Care Workforce Capacity

Physician Supply and Shortage

The following points describe the current state and near-term trajectory of New York’s primary care physician supply, including shortage areas and projected gaps.

Less than 25% of physicians in New York practice primary care (comparable to national trends).
Primary care physician supply has grown by only 3.6% per year nationally since 2016, vs. 8.7% growth among other specialties.
More than one-third of New York’s primary care physicians are over age 60 — an impending wave of retirements.
4.7 million New Yorkers live in Primary Care Health Professional Shortage Areas (HPSAs).
Addressing statewide shortages will require an estimated 1,013 additional primary care providers.

Nurse Practitioners and Physician Assistants

NPs and PAs are an increasingly important segment of the primary care workforce in New York, particularly in underserved and rural areas. The following points summarize their role, growth, and the policy barriers they face.

NPs and PAs now make up approximately 30% of New York’s primary care workforce.
The NP workforce grew 27% between 2018–2022.
Approximately half of rural primary care practices employ at least one NP or PA.
NP participation in Medicaid grew from 127 to 180 per 100,000 enrollees between 2016–2021.
Under current policy, NPs in most states including New York receive 85–95% of the physician rate for comparable services. States with Medicaid reimbursement parity between NPs and physicians report cost-neutrality or cost savings.

Medical Assistants and Community Health Workers

Medical assistants (MAs) and community health workers (CHWs) extend the capacity of primary care teams. Their roles, workforce size, growth projections, and recent policy changes are summarized below.

New York employs nearly 40,000 medical assistants (MAs), with the workforce projected to grow 27% by 2032.
New York is the only state that prohibits trained MAs from administering vaccines. Two-thirds of recently surveyed providers say they would delegate vaccinations to MAs if permitted; expanded MA roles could reduce burnout (59% of providers) and increase productivity (48%).
The CHW workforce is projected to grow 23% by 2032.
In 2023, New York joined 32 other states in reimbursing for CHW services via a Medicaid State Plan Amendment, and subsequently secured CMS approval to reimburse community-based organizations for CHW services through a Section 1115 waiver.

Primary Care Provider Density by Area Type

The table below shows primary care provider density per 100,000 population across metropolitan, micropolitan, small town, and rural areas, broken down by provider type.

Area Type	NPs per 100k	PAs per 100k	MDs / DOs per 100k
Metropolitan	36.30	7.03	108.07
Micropolitan	51.23	12.08	68.87
Small Town	52.46	11.36	71.18
Rural	26.46	9.36	35.56

Rural areas have only 35.56 MDs/DOs per 100,000 — about one-third the metropolitan rate (108.07). NP density is higher in small towns (52.46) and micropolitan areas (51.23) than in metro areas (36.30), indicating NPs are partially compensating for physician shortages in less urban settings. Rural areas have the lowest density of every provider type.

Rural Access Challenges

More than 3 million New Yorkers live in rural communities. Rural areas face overlapping patient needs and primary care pressures, with providers covering broader scopes of care with limited resources. The following points summarize the key access barriers and their consequences.

Rural areas have approximately 25% fewer primary care providers per capita than urban areas.
Potentially preventable hospitalization rates are nearly 50% higher in some rural counties than the state average.
In some rural counties, more than 25% of residents are aged 65+, and chronic disease rates are 20% higher than the state average.
One in four rural households in New York lacks high-speed broadband, limiting the role telehealth can play.
Rural residents are more likely to encounter transportation barriers: longer travel times, greater distances to providers, and limited public transit.
Federal and state budget cuts — including HR1 budget rescissions and Medicaid reductions — place rural hospitals and clinics at disproportionate risk of closure or service reduction, which could further overcrowd already-strained rural primary care practices and community health centers.

Rural New York faces a compounding crisis: an older and sicker population, far fewer providers, infrastructure gaps that limit telehealth, and mounting funding threats. The consequences are visible in hospitalization rates that run up to 50% above the state average in some counties.

Primary Care Investment and Economics

Current Investment Levels and Cost of Underinvestment

The following points document the current level of primary care spending in New York and the measurable costs attributable to its underinvestment, including avoidable emergency and inpatient utilization.

Primary care receives only 3–5% of New York’s total health spending — well below the 10–12% recommended by national experts and seen in other high-income countries.
Primary care’s share of total spending has declined in recent years.
New York spends more than $300 billion annually on health care, with per capita hospital expenditures 43% above the national average (2020 data), yet achieves only average health outcomes.
Average cost of an ED visit in New York: $1,200 vs. $300 for a primary care visit.
Approximately 7 in 10 hospital-based ED visits are non-emergent or could have been treated in a primary care setting.
Avoidable hospitalizations and ED use cost New York State hundreds of millions of dollars each year.

Evidence for Returns on Primary Care Investment

More than 20 states have adopted primary care measurement requirements or spending targets. The table summarizes early results from states that have increased primary care investment, providing an evidence base for New York’s own reform trajectory.

Source / State	Finding
Oregon	Every additional $1 invested in primary care generated $13 in savings across emergency, specialty, and hospital services.
Massachusetts	Provider organizations investing more in primary care delivered significantly better quality while spending less on inpatient and outpatient hospital services.
Rhode Island	Increasing primary care investment expands the number of practicing primary care providers, helping address shortages and improve quality.
National (Medicaid)	A $10 increase in Medicaid provider reimbursement per visit increases the likelihood that an enrollee sees a doctor within two weeks by 1.4%.

New York–Specific Cost Savings Projections (2025 Analysis)

A 2025 New York-specific analysis of commercial insurance claims modeled the effect of giving high- and medium-high-risk enrollees two additional primary care visits per year. The table presents projected savings at both the individual and statewide level.

Scenario	Year 1 Savings	Year 2 Savings
Per member per year (PMPY) — targeted enrollees	$26.10 PMPY	$79.20 PMPY
Applied statewide to commercially insured New Yorkers	$248.8 million	$753.4 million

The evidence from other states and New York’s own 2025 modeling is compelling: targeted investment in primary care generates multiples in downstream savings. The Primary Care Investment Act (S1634/A1915A), passed by the New York Senate in 2025, would raise primary care’s share of total spending from an estimated 5% to 12.5%, potentially unlocking hundreds of millions in annual savings within two years of implementation.

Health Disparities and Racial Equity

Health outcomes and hospital experiences in New York are systematically unequal across racial, ethnic, and geographic lines. This section brings together statewide disparity data from the 2025 NY Health Foundation brief, Medicare patient distribution data across 84 NYC-area hospitals (2010), and the 2013 pediatric payer and race breakdown.

Statewide Health Outcome Disparities

The following list presents key disparity indicators for New York State, comparing outcomes for Black and Latino New Yorkers against white New Yorkers, and rural against statewide averages.

Chronic disease burden: More than 40% of New York adults live with at least one chronic disease; 6 in 10 deaths are attributable to chronic disease
Preventable hospitalizations — Black New Yorkers: Rate is 2.2× higher than for white New Yorkers
Preventable hospitalizations — Latino New Yorkers: Rate is 1.4× higher than for white New Yorkers
Premature death (under 75 years) — Black New Yorkers: Rate is 1.9× higher than for white New Yorkers
Premature death (under 75 years) — Latino New Yorkers: Rate is 1.2× higher than for white New Yorkers
Rural chronic disease rates: 20% higher than the state average in some counties
Rural preventable hospitalization rates: Nearly 50% higher in some rural counties vs. the state average

The disparity in preventable hospitalizations is especially striking: Black New Yorkers are hospitalized preventably at more than twice the rate of white New Yorkers. These gaps reflect structural inequities in access to primary and preventive care, compounded by chronic underinvestment in communities of color.

Racial Composition of Medicare Patients by County — NYC Metro Region

A peer-reviewed analysis of 2010 Medicare fee-for-service data covering 84 hospitals in the NYC metropolitan region (9 counties) found significant racial and ethnic segregation in hospital use. Across the entire region, 66.6% of Medicare patients were non-Hispanic White (NHW), 15.1% non-Hispanic Black (NHB), 13.0% Hispanic, and 3.7% Asian/Pacific Islander/Alaskan Native/American Indian (API/AIAN). The table below shows racial composition and average CMS quality ratings by county.

County	NHW %	NHB %	Hispanic %	API/AIAN %	Minorities %	Avg Quality Rating	Dual Medicare/ Medicaid %
Bronx	19.2	28.6	42.7	6.1	80.8	1.3	74.6
Kings (Brooklyn)	34.5	40.5	18.5	3.3	65.5	1.4	69.5
Nassau	80.4	11.5	4.8	2.2	19.6	2.4	24.3
New York (Manhattan)	49.5	22.4	20.3	6.4	50.5	3.3	47.8
Queens	47.3	23.1	16.7	9.6	52.7	1.7	60.8
Richmond (Staten Island)	76.0	9.7	9.5	3.2	24.0	1.5	42.9
Rockland	83.2	8.2	5.5	2.4	16.8	2.0	23.1
Suffolk	88.3	5.3	4.5	1.2	11.7	2.9	20.9
Westchester	73.6	15.8	7.6	2.1	26.4	2.4	27.5

NHW = Non-Hispanic White; NHB = Non-Hispanic Black; API/AIAN = Asian/Pacific Islander, Alaskan Native/American Indian.

Counties with the highest share of minority Medicare patients — the Bronx (80.8%) and Brooklyn (65.5%) — have the lowest average CMS quality ratings (1.3 and 1.4) and the highest dual Medicare/Medicaid enrollment rates (74.6% and 69.5%). By contrast, suburban counties with majority white patient populations (Nassau, Suffolk, Rockland) show higher quality ratings and lower dual enrollment rates. The proportion of NHB and Hispanic patients is negatively correlated with hospital quality ratings (Spearman ρ = −0.57 and −0.40 respectively, both p < 0.0001).

Hospital Segregation — Dissimilarity Index, NYC Metropolitan Region

The Dissimilarity Index (DI) measures the share of patients who would need to switch hospitals to achieve a perfectly integrated distribution. The study analyzed 84 hospitals across 9 counties, 6 hospital referral regions (HRRs), and 37 hospital service areas (HSAs). The table presents DI values for each racial/ethnic group at four geographic levels.

Geographic Level	NHW DI	NHB DI	Hispanic DI	API/AIAN DI
NYC Metropolitan Region (n=1)	40.1%	36.1%	37.6%	30.3%
Counties (n=9) — median (IQR)	23.5% (18.1–25.7%)	23.5% (20.9–26.8%)	20.2% (14.2–21.5%)	13.7% (11.2–22.3%)
HRRs (n=6) — median (IQR)	27.5% (14.5–32.1%)	18.2% (8.1–29.6%)	23.7% (11.9–25.9%)	10.5% (8.6–20.2%)
HSAs (n=37) — median (IQR)	16.9% (11.5–21.2%)	13.4% (4.6–17.9%)	13.6% (8.5–20.5%)	12.0% (8.3–13.8%)

At the regional level, 40.1% of non-Hispanic White patients (and equivalently, 40.1% of minority patients) would need to switch hospitals for the system to be fully integrated. DI values decline as geographic units become smaller but remain meaningful even at the hospital service area level (12–17%). For comparison, public school segregation nationally is approximately 32%, and residential Black-White DI in the New York–Jersey City metro area was 79.1 in 2010. Hospital segregation extends beyond Black patients to Hispanic and API/AIAN populations.

Race, Ethnicity, and Payer in Pediatric Hospital Care (2013)

The 2013 pediatric SPARCS analysis provides a detailed racial/ethnic and payer breakdown of the 125,114 non-newborn inpatient discharges and 1,428,433 ER visits for children under 18. The list below shows the share of inpatient discharges by race/ethnicity and primary payer.

White, non-Hispanic: 35.3% — largest single group
Hispanic: 23.8%
Black, non-Hispanic: 22.6%
Asian: 3.7%
Other / unspecified: 14.5%
Primary payer — Medicaid (non-CHP): 61.0%
Primary payer — Private insurance: 31.1%
Primary payer — Child Health Plus (CHP): 2.0%

Among the Pediatric Quality Indicators (PDIs), race/ethnicity differences were also observed:

Asthma discharges were most frequent among Black, non-Hispanic children.
Diabetes and gastroenteritis discharges were more frequent among White, non-Hispanic children.
Hispanic children had more urinary tract infection discharges than any other racial/ethnic group.

Medicaid covers nearly two-thirds of all pediatric hospital encounters in New York State — a direct reflection of the income distribution of families with children. Black and Hispanic children face a disproportionate burden of asthma hospitalizations, mirroring the broader statewide pattern of racial health disparities documented throughout this report.

Data Systems: SPARCS and NYPORTS

New York’s hospital data infrastructure underpins all reporting in this article. This section describes the two primary systems — SPARCS and NYPORTS — including their scope, methodology, and classification frameworks.

SPARCS — Statewide Planning and Research Cooperative System

SPARCS was established in 1979 under Section 28.16 of the Public Health Law. It collects patient-level detail on diagnoses, treatments, services, and charges for every hospital discharge, ambulatory surgery, outpatient service, and emergency department visit in New York State. Any facility certified to provide Article 28 inpatient, ambulatory surgery, ED, or outpatient services is required to submit data. This includes both hospital-owned and free-standing Diagnostic and Treatment Centers (D&TCs). Data are released in three tiers: de-identified (public under FOIL), limited, and identifiable.

Classification Software Versions by Discharge Year

SPARCS uses two classification frameworks: the Clinical Classifications Software for Research (CCSR) for diagnoses and procedures, and the All Patient Refined Diagnosis Related Groups (APR-DRG) system for severity and resource use. The table below shows which version of each framework was applied to each discharge year, enabling longitudinal comparability analysis.

Discharge Year	CCSR Diagnosis	CCSR Procedure	APR-DRG Version
2018	2021.2	2021.1	v35
2019	2021.2	2021.1	v36
2020	2021.2	2021.1	v37
2021	2023.1	2023.1	v38
2022	2023.1	2023.1	v39
2023	2025.1	2025.1	v40
2024	2025.1	2025.1	v41

Costing Methodology

Inpatient cost estimates are calculated using hospital discharge data from SPARCS and Institutional Cost Report (ICR) data. ICRs include facility-level Ratios of Cost to Charges (RCCs) — certified, calculated, reported, and subject to external audit. For example: a hospital charge of $20,000 with an RCC of 50% yields an estimated cost of $10,000. Where an RCC exceeds the Medicare ceiling without reasonable explanation, it is replaced by the hospital’s average RCC. The audited RCC file used for 2023 discharge cost estimates is the 2019 RCC version; the file used for 2024 discharge cost estimates is the 2021 RCC version.

NYPORTS — New York Patient Occurrence Reporting and Tracking System

NYPORTS requires mandatory adverse event reporting from all New York State–certified health facilities. In 2023, reporting covered hospitals (including critical access and sole community hospitals), ambulatory surgery centers (ASCs), and diagnostic and treatment centers (D&TCs). The 2023 data file was released as of December 6, 2024. Occurrence rates are expressed per 10,000 discharges. D&TC discharge volumes are suppressed in public releases to protect patient privacy.

Conclusion

New York’s hospital system is large and well-funded — with 266 hospitals, $403 billion in patient revenue, and over 2.1 million inpatient discharges annually — yet its performance remains weak. Despite spending 43% more per capita on hospital care than the national average, the state ranks 48th out of 50 in hospital quality ratings and achieves only average health outcomes.

Two major structural problems drive this gap. First is the underinvestment in primary care: only 3–5% of health spending goes to primary care, far below the recommended 10–12%. This contributes to overloaded emergency departments, preventable hospitalizations, and primary care shortages affecting 4.7 million residents. Second are persistent geographic and racial disparities, with preventable hospitalization rates more than twice as high for Black New Yorkers and significantly higher in some rural counties.

At the same time, the data suggest clear paths for reform. Increasing primary care investment and linking hospital funding to quality outcomes could improve both efficiency and equity in New York’s healthcare system.