New Yorkers Speak Up: Community Perspectives on Improving Healthcare Experiences in New York City

De facto segregation by racial identity and insurance persists in US hospitals, leading to health disparities. To understand factors driving healthcare segregation and NYC residents' experiences, we conducted the Health Equity and Access to Care project. The present study explores NYC residents' perspectives on and recommendations to mitigate healthcare segregation. To recruit English-speaking NYC residents (n = 184) stratified by race/ethnicity and insurance status for virtual and in-person focus groups (FG, n = 35), we utilized a multipronged outreach strategy with community groups and a research firm. We employed constructivist grounded theory and applied structural racism frameworks, Penchansky and Thomas' dimensions of healthcare access, and the socioecological model to guide the analysis of participants' perspectives on improving care. Participants described priorities across accessibility, availability, affordability, accommodation, and acceptability domains, while thematic differences emerged by race/ethnicity and insurance status (e.g., White participants highlighted how health system bureaucratic inefficiencies perpetuated harmful healthcare experiences whereas Black participants discussed how institutional and employment factors contributed to staff burnout, negative patient experiences). Structural factors (e.g., residential segregation, neighborhood resources, underinvestment in safety-net systems) were perceived as drivers of harmful healthcare experiences across all domains. Priorities for change include anti-bias training, authentic community engagement, patient navigation and digital connectivity investments, transparent and accessible healthcare operations, investment in neighborhood-based healthcare, and building a diverse workforce. Participants' recommendations call for coordinated, multidisciplinary efforts across interpersonal, community, institutional, and structural domains co-designed with communities. Elevating community voices can support stakeholders to act on the necessary levers to desegregate healthcare and advance health equity.