Better Health Care Through Data Visualization

For Amanda Dunker, the experience of copying and pasting the details of hospital lawsuits thousands of times became a catalyst for change.

“I just thought there must be a better way to do some of this stuff,” the health policy director at Community Service Society of New York (CSS) says of her recent labor-intensive effort to document the legal actions of New York hospitals against patients with unpaid fees.

Figuring out more efficient ways to gather such data and use it to tell compelling stories inspired Dunker to enroll in the Graduate Center’s master’s program in Data Analysis and Visualization. In her role at CSS, Dunker advocates for improved health care for low- and middle-income New Yorkers. She identifies issues of concern, studies those issues to determine whether the problem is widespread, and presents her findings to policymakers in Albany who can enact related legislation. 

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“Sometimes it’s easy to dismiss an individual person’s story” as isolated or anomalous, Dunker says. Without the data to show a wider pattern, issues that can have profound impacts on the lives of patients, such as errors in billing, are often shrugged off.

“A mistake happens somewhere with either the insurance company or the hospital or whoever,” Dunker says, “and then the patient ends up in this nightmare spiral where they end up in court, they end up with outrageous bills, and then when we figure out where the mistake happened, it gets treated like it’s an individual issue: ‘Oh, well, we just made this mistake this time and we'll try not to do it again.’ But if it didn’t keep happening, we wouldn’t have people keep calling us because it’s happened to them.”

In the case of the hospital lawsuits, Dunker says, some digging revealed that the practice of suing patients for medical debt was surprisingly common, as was garnishing their wages to collect. Her investigation found that 98% of such cases in New York are won by default — suggesting that patients may not be able to afford attorneys — and that many of those whose wages were garnished worked in low-wage occupations.

“All hospitals in New York State are nonprofit charities,” Dunker says. “So when we see them doing something like suing somebody, that’s going pretty far, we think, for a charity.”

Such findings, Dunker says, can be a key to persuading lawmakers to act. A bill she supported that would ban hospitals from garnishing patients’ wages or imposing liens on their primary residences recently passed in the New York State legislature and now awaits Governor Kathy Hochul’s signature. Dunker has also co-authored reports on ways to narrow New York’s health insurance coverage gap and how inequalities in New York’s health care system worsened health disparities during the COVID-19 pandemic, among other topics. 

She also sees implications in her work for health care policy nationwide. “What’s happened in New York really forces us to consider this question of a private system for distributing health care versus a public system,” Dunker says. “When the Affordable Care Act passed, New York took advantage of everything in it, so that people could get into insurance programs. But we still have a lot of people who have their finances ruined by medical bills. So I think we have to have these discussions about what does it mean to have privately distributed health care, and is this the best we can do?”

Learning more about data analysis and visualization, she hopes, will give her new tools to address the need in New York. She was looking forward to joining the CUNY community — a rite of passage she likens to getting a New York City library card — and starting her studies.

“It’s going to be a little bit challenging, working full time and going to school,” Dunker says. “That’s one reason I thought the CUNY Graduate Center was a good fit. CUNY is a great place for nontraditional students. I can’t take classes during the day, so my program is all evening classes, and I really appreciate that.”

Published by the Office of Communications and Marketing