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Identifying Provider Prejudice in Healthcare

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  • Amitabh Chandra
  • Douglas O. Staiger

Abstract

We use simple economic insights to develop a framework for distinguishing between prejudice and statistical discrimination using observational data. We focus our inquiry on the enormous literature in healthcare where treatment disparities by race and gender are not explained by access, preferences, or severity. But treatment disparities, by themselves, cannot distinguish between two competing views of provider behavior. Physicians may consciously or unconsciously withhold treatment from minority groups despite similar benefits (prejudice) or because race and gender are associated with lower benefit from treatment (statistical discrimination). We demonstrate that these two views can only be distinguished using data on patient outcomes: for patients with the same propensity to be treated, prejudice implies a higher return from treatment for treated minorities, while statistical discrimination implies that returns are equalized. Using data on heart attack treatments, we do not find empirical support for prejudice-based explanations. Despite receiving less treatment, women and blacks receive slightly lower benefits from treatment, perhaps due to higher stroke risk, delays in seeking care, and providers over-treating minorities due to equity and liability concerns.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 16382.

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Date of creation: Sep 2010
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Handle: RePEc:nbr:nberwo:16382

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  1. Shamena Anwar & Hanming Fang, 2005. "An Alternative Test of Racial Prejudice in Motor Vehicle Searches: Theory and Evidence," NBER Working Papers 11264, National Bureau of Economic Research, Inc.
  2. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115, pages 103-140.
  3. John Knowles & Nicola Persico & Petra Todd, . ""Racial Bias in Motor Vehicle Searches: Theory and Evidence''," CARESS Working Papres 99-06, University of Pennsylvania Center for Analytic Research and Economics in the Social Sciences.
  4. Kate L. Antonovics & Brian G. Knight, 2004. "A New Look at Racial Profiling: Evidence from the Boston Police Department," NBER Working Papers 10634, National Bureau of Economic Research, Inc.
  5. Heckman, James J. & Urzua, Sergio & Vytlacil, Edward, 2006. "Understanding Instrumental Variables in Models with Essential Heterogeneity," IZA Discussion Papers 2320, Institute for the Study of Labor (IZA).
  6. Munnell, Alicia H. & Geoffrey M. B. Tootell & Lynn E. Browne & James McEneaney, 1996. "Mortgage Lending in Boston: Interpreting HMDA Data," American Economic Review, American Economic Association, vol. 86(1), pages 25-53, March.
  7. Barsky R. & Bound J. & Charles K.K. & Lupton J.P., 2002. "Accounting for the Black-White Wealth Gap: A Nonparametric Approach," Journal of the American Statistical Association, American Statistical Association, vol. 97, pages 663-673, September.
  8. John List, 2004. "The nature and extent of discrimination in the marketplace: Evidence from the field," Natural Field Experiments 00299, The Field Experiments Website.
  9. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
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Cited by:
  1. Debopam Bhattacharya & Shin Kanaya & Margaret Stevens, 2014. "Are University Admissions Academically Fair?," CREATES Research Papers 2014-06, School of Economics and Management, University of Aarhus.
  2. Jonathan Wadsworth, 2012. "Musn’t Grumble. Immigration, Health and Health Service Use in the UK and Germany," Norface Discussion Paper Series 2012028, Norface Research Programme on Migration, Department of Economics, University College London.
  3. Jonathan Wadsworth, 2012. "Musn’t Grumble. Immigration, Health and Health Service Use in the UK and Germany," CReAM Discussion Paper Series 1221, Centre for Research and Analysis of Migration (CReAM), Department of Economics, University College London.
  4. Shamena Anwar & Hanming Fang, 2011. "Testing for the Role of Prejudice in Emergency Departments Using Bounceback Rates," PIER Working Paper Archive 11-007, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania.

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