Racial, ethnic, and socioeconomic disparities in both health care and health are well documented, butour understanding of the causes of such disparities, and potential solutions, remains incomplete. Previousresearch has stressed the importance of geography in understanding health care disparities, but these broadregional findings have precluded hospital-level information (or 'report cards') on racial or ethnic disparities.Nor do we understand the implications for disparities if Black and white patients from the same neighborhoodseek care at different types of hospitals. Our recently completed patient survey suggests large differences by race and ethnicity in beliefs abouthealth care intensity. But we don't know how perceptions of white, Black, Hispanic, and lower incomepatients translate into the type of care they actually receive. Finally, it is well understood that surgical ratesare lower among Black AMI patients, but it is not well understood what the implications are of these lowersurgical rates for disparities in health outcomes; and more importantly, what would be the benefits of raisingBlack surgical rates following AMI.
The specific aims are: 1. Develop hospital-level disparity 'report cards' for hospital performance with regard to racial, ethnic, orincome-based differences in treatment patterns such as quality of care measures and knee and hipreplacements using patient-doctor-hospital networks estimated in Core B and Project 1, and quantify thedifferences in the quality of health care institutions and providers utilized by Black and white patients. 2. Characterize the sorting of patients and providers by race, ethnicity, and socioeconomic status. What isthe impact on health outcomes when minority or low-income patients seek care (or are only able to receivecare) at largely Black/Hispanic or low-income hospitals, whether through choice or because of hospitalclosures? 3. Test whether the preferences of patients, as elicited by a recent nation-wide survey of Medicareenrollees, are reflected in the type of health care they subsequently receive, and whether this concordancevaries systematically by race, ethnicity, or socioeconomic status using linked Medicare claims data. 4. Estimate the impact of differential racial, ethnic, and income-based cardiac surgical rates on disparitiesin health outcomes using a large sample (3 million observation) of elderly heart attack patients. Do Blacksurgical candidates experience better, at the margin, than white surgical candidates?
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