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Geography and Racial Health Disparities

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  • Amitabh Chandra
  • Jonathan Skinner

Abstract

An extensive literature has documented racial, ethnic, and socioeconomic disparities in health care and health outcomes. We argue that the influence of geography in medical practice needs to be taken seriously for both the statistical measurement of racial disparities, and in designing reforms to reduce disparities. Past research has called attention to disparities that occur within hospitals or provider groups; for example black patients who are treated differently from whites within a hospital. We focus on a different mechanism for disparities; African-Americans tend to live in areas or seek care in regions where quality levels for all patients, black and white, are lower. Thus ensuring equal access to health care at the local or hospital level may not by itself erase overall health care disparities. However, reducing geographic disparities in both the quality of care, and the quality of health care decisions by patients, could have a first-order impact on improving racial disparities in health care and health outcomes.

Suggested Citation

  • Amitabh Chandra & Jonathan Skinner, 2003. "Geography and Racial Health Disparities," NBER Working Papers 9513, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:9513
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    Cited by:

    1. David M. Cutler & Adriana Lleras-Muney & Tom Vogl, 2008. "Socioeconomic Status and Health: Dimensions and Mechanisms," NBER Working Papers 14333, National Bureau of Economic Research, Inc.
    2. Blanchflower, David G. & Wainwright, Jon, 2005. "An Analysis of the Impact of Affirmative Action Programs on Self-Employment in the Construction Industry," IZA Discussion Papers 1856, Institute for the Study of Labor (IZA).
    3. Christopher H. Wheeler, 2007. "Human capital externalities and adult mortality in the U.S," Working Papers 2007-045, Federal Reserve Bank of St. Louis.
    4. Doyle Jr., Joseph J. & Ewer, Steven M. & Wagner, Todd H., 2010. "Returns to physician human capital: Evidence from patients randomized to physician teams," Journal of Health Economics, Elsevier, vol. 29(6), pages 866-882, December.
    5. Miller, Douglas L. & Paxson, Christina, 2006. "Relative income, race, and mortality," Journal of Health Economics, Elsevier, vol. 25(5), pages 979-1003, September.
    6. Tullio Jappelli & Mario Padula, 2003. "The Quality of Health Care: Evidence from Italy," Giornale degli Economisti, GDE (Giornale degli Economisti e Annali di Economia), Bocconi University, vol. 62(1), pages 7-34, April.
    7. Tullio Jappelli & Luigi Pistaferri & Guglielmo Weber, 2007. "Health care quality, economic inequality, and precautionary saving," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 327-346.
    8. Emilia Simeonova, 2009. "Race, Quality of Care and Patient Outcomes: What Can We Learn from the Department of Veterans Affairs?," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 37(3), pages 279-298, September.
    9. Chatterji, P & Joo, H & Lahiri, K, 2011. "Beware of Being Unaware: Racial Disparities in Chronic Illness in the US," Health, Econometrics and Data Group (HEDG) Working Papers 11/11, HEDG, c/o Department of Economics, University of York.
    10. 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.
    11. Antonio J. Trujillo & John A. Vernon & Laura Rodriguez Wong & Gustavo Angeles, 2005. "Race and Health Disparities Among Seniors in Urban Areas in Brazil," NBER Working Papers 11690, National Bureau of Economic Research, Inc.
    12. Anna Aizer & Adriana Lleras-Muney & Mark Stabile, 2005. "Access to Care, Provider Choice, and the Infant Health Gradient," American Economic Review, American Economic Association, vol. 95(2), pages 248-252, May.
    13. Pinka Chatterji & Heesoo Joo & Kajal Lahiri, 2010. "Beware of Unawareness: Racial/Ethnic Disparities in Awareness of Chronic Diseases," NBER Working Papers 16578, National Bureau of Economic Research, Inc.
    14. Joseph J. Doyle, Jr. & Steven M. Ewer & Todd H. Wagner, 2008. "Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams," NBER Working Papers 14174, National Bureau of Economic Research, Inc.
    15. David C. Grabowski & Jonathan Gruber & Joseph J. Angelelli, 2006. "Nursing Home Quality as a Public Good," NBER Working Papers 12361, National Bureau of Economic Research, Inc.
    16. Arthur Kennickell & Annamaria Lusardi, 2004. "Disentangling the Importance of the Precautionary Saving Mode," NBER Working Papers 10888, National Bureau of Economic Research, Inc.
    17. Johnson Rucker C., 2012. "Health Dynamics and the Evolution of Health Inequality over the Life Course: The Importance of Neighborhood and Family Background," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(3), pages 1-69, January.
    18. Andrew Fenelon & Samuel Preston, 2012. "Estimating Smoking-Attributable Mortality in the United States," Demography, Springer;Population Association of America (PAA), vol. 49(3), pages 797-818, August.
    19. Sherry Glied & Adriana Lleras-Muney, 2008. "Technological innovation and inequality in health," Demography, Springer;Population Association of America (PAA), vol. 45(3), pages 741-761, August.
    20. Brian S. Armour & M. Melinda Pitts, 2007. "Does disability explain state-level differences in the quality of Medicare beneficiary hospital inpatient care?," FRB Atlanta Working Paper 2007-18, Federal Reserve Bank of Atlanta.
    21. Bhattacharya, Jay & Lakdawalla, Darius, 2006. "Does Medicare benefit the poor?," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 277-292, January.
    22. Hendrik Jürges & Vincent Pohl, 2012. "Medical guidelines, physician density, and quality of care: evidence from German SHARE data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 635-649, October.

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • J1 - Labor and Demographic Economics - - Demographic Economics

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