Working Paper: NBER ID: w30380
Authors: Manasvini Singh; Atheendar Venkataramani
Abstract: We hypothesize that deepening resource scarcity results in rationing on the basis of group identity in settings with underlying discrimination. We provide evidence of such race-based rationing in a high-stakes setting: health care. Using detailed, time-stamped data on 107,000 patient admissions to a large health system, we find that in-hospital mortality increases for Black, but not White, patients as hospitals reach capacity (a state of resource scarcity likely to trigger or exacerbate biases in decision-making). As a mechanism, we identify rationing by wait time, documenting that sick Black patients wait longer for care than healthy White patients at every capacity level, likely because of systematic misevaluation of medical need. Text analysis of unstructured provider notes reveals differential rationing of provider effort by race as another potential mechanism. Together, these findings demonstrate important linkages between three key economic concepts: scarcity, discrimination, and rationing.
Keywords: capacity strain; racial disparities; hospital mortality
JEL Codes: I10; I14; J15
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| hospital capacity strain (I19) | racial disparities in in-hospital mortality (I14) |
| hospital capacity strain (I19) | in-hospital mortality for black patients (I14) |
| wait times (C41) | in-hospital mortality for black patients (I14) |
| hospital capacity strain (I19) | in-hospital mortality for white patients (I14) |
| in-hospital mortality for black patients (I14) | racial disparities in in-hospital mortality (I14) |
| hospital strain (I19) | biases in provider behavior (J71) |
| hospital strain (I19) | challenges in patient self-advocacy (I11) |