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Identifying Provider Prejudice in Healthcare

  • Amitabh Chandra
  • Douglas O. Staiger

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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File URL: http://www.nber.org/papers/w16382.pdf
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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
Note: AG HC HE LS
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  1. 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.
  2. 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).
  3. 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.
  4. Shamena Anwar & Hanming Fang, 2006. "An Alternative Test of Racial Prejudice in Motor Vehicle Searches: Theory and Evidence," American Economic Review, American Economic Association, vol. 96(1), pages 127-151, March.
  5. 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.
  6. John List, 2004. "The nature and extent of discrimination in the marketplace: Evidence from the field," Natural Field Experiments 00299, The Field Experiments Website.
  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. Alicia H. Munnell, 1992. "Mortgage lending in Boston: interpreting HMDA data," Working Papers 92-7, Federal Reserve Bank of Boston.
  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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