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Black-White Disparities in Care in Nursing Homes


  • David Grabowski


  • Thomas McGuire


Nursing homes serve many severely ill poor people, including large numbers of racial/ethnic minority residents. Previous research indicates that blacks tend to receive care from lower quality nursing homes. Using the Institute of Medicine (IOM) definition of racial-ethnic disparities, this study decomposes nursing home disparities into within and across facility components. Using detailed person-level nursing home data, we find meaningful black-white disparities for one of the four risk-adjusted quality measures, with both within and across nursing home components of the disparity. The IOM approach, which recognizes mediation through payer status and education, has a small effect on measured disparities in this setting. Although we did not find disparities across the majority of quality measures and alternate disparity definitions, this approach can be applied to other health care services in an effort to disentangle the role of across and within facility variation and the role of potential mediators on racial/ethnic disparities. Copyright International Atlantic Economic Society 2009

Suggested Citation

  • David Grabowski & Thomas McGuire, 2009. "Black-White Disparities in Care in Nursing Homes," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 37(3), pages 299-314, September.
  • Handle: RePEc:kap:atlecj:v:37:y:2009:i:3:p:299-314
    DOI: 10.1007/s11293-009-9185-7

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    References listed on IDEAS

    1. Amitabh Chandra & Jonathan Skinner, 2003. "Geography and Racial Health Disparities," NBER Working Papers 9513, National Bureau of Economic Research, Inc.
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    More about this item


    Racial disparities; Long-term care; Decomposition methods; I10; J15;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination


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