Healthcare Hot-spotting
If we are to draw a parallel with the context of information technologies, racial fixes are better understood not as viruses but as a part of the underlying code of operating systems – often developed as solutions to particular kinds of predicaments without sufficient awareness of the problems that they help produce and preserve.
In the United States, for example, 5 percent of Americans account for nearly 50 percent of healthcare costs and 1 percent comprise 20 percent of costs, and so the practice of healthcare “hot-spotting” is a kind of market segmentation. According to this approach, which started in Camden, New Jersey, the purpose of healthcare hot-spotting is the “strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients,” or what they call super-utilizers.33 In Camden, 13 percent of the population accounts for 80 percent of healthcare costs. In 2007 a coalition of healthcare providers started using (insurance claims) data from all three city hospitals to examine the relationship between geography, utilization, cost, and other variables. They also employ “Geographic Information Systems (GIS) technologies and spatial profiling to identify populations that are medically vulnerable (‘health care’s costliest 1%’),”34 a form of techno- benevolence that blurs the line between niche tailoring and unwanted targeting.
Family physician Jeffrey Brenner, who founded the healthcare hotspotting initiative, was inspired by the work of the New York Police Department. According to Nadine Ehlers and Shiloh Krupar in “When Treating Patients Like Criminals Makes Sense,” hot-spotting uses not only GIS but also the principles of racial profiling. They focus on “how attempts to lower the monetary debt incurred by hospitals – through this new form of race-based medicine – situates minorities as responsible for this debt and actually re-entrenches racial disparity” and those targeted “are often classified as ‘socially disintegrated,’ as dependent, and as unable to self-care.”35 The medical and economic intervention, in short, fixes people into stigmatizing categories – the very forms of classificatory stigma that restrict people’s life chances and fuel health disparities in the first place.