Rationing by Race

Discrimination may lead to rationing on the basis of group identity when resources become more scarce. We provide evidence of consequential rationing on the basis of an individual’s race in a high-stakes setting: health care. Using detailed, time-stamped data on over 107,000 patient admissions from a large health system in the U.S., we find that in-hospital mortality increased for Black, but not White, patients as hospitals reached capacity, a state where biases in care provision are likely to emerge or be exacerbated. We identify rationing by wait times as a mechanism, also documenting that sick Black patients wait longer for care than healthy White patients, regardless of capacity levels. Applying text analysis techniques to clinical documentation, we provide suggestive evidence of disparities in provider effort as another mechanism.