Working Paper: NBER ID: w28018
Authors: Amitabh Chandra; Pragya Kakani; Adam Sacarny
Abstract: We develop a simple framework to measure the role of hospital allocation in racial disparities in health care and use it to study Black and white Medicare patients who are treated for heart attacks – a condition where virtually everyone receives care, hospital care is highly effective, and hospital quality has been validated. We report four facts. (1) Black patients receive care at lower-performing hospitals than white patients, even when they live in the same hospital market or ZIP code within a hospital market. (2) Over the past two decades, the gap in performance between hospitals treating Black and white patients shrank by over two-thirds. (3) This progress is due to more rapid performance improvement at hospitals that tended to treat Black patients, rather than faster reallocation of Black patients to better hospitals. (4) Hospital performance improvement is correlated with adoption of a high-return low-cost input, beta-blockers. Closing remaining disparities in allocation and harnessing the forces of performance improvement, including technology diffusion, may be novel levers to further reduce disparities.
Keywords: hospital allocation; racial disparities; health care; Medicare; heart attacks
JEL Codes: D24; I11; I14
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| black patients receive care at lower-performing hospitals (I14) | lower health care outcomes (I14) |
| improved performance at hospitals serving black patients (I14) | narrowing of racial gap in health care outcomes (I14) |
| adoption of beta-blockers (C46) | improved performance at hospitals serving black patients (I14) |
| differential performance improvement at hospitals (D29) | reduction in racial gap in health care outcomes (I14) |
| differences in hospitals treating black and white patients (I14) | remaining disparities in hospital performance (I14) |
| hospital reallocation (I19) | narrowing of racial gap in health care outcomes (I14) |