Statistical discrimination in health care

Balsa, Ana I.; McGuire, Thomas G.

doi:10.1016/s0167-6296(01)00101-1

Cited by 149 publications

(111 citation statements)

References 56 publications

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“…Doctors' "stereotypes" that minority patients are less likely to comply with treatment, for example, might generate disparities. Finally, in an earlier paper, we show how the presence of greater uncertainty in interpreting symptoms of disease for minority patients can itself be a source of disparate treatment, even among fair-minded providers (Balsa and McGuire, 2001). 4 All three of these explanations are a form of what social psychologists label "group categorization," that is, acting toward a person based in part on their membership in a social group like race or ethnicity.…”

Section: Introductionmentioning

confidence: 87%

“…Phelps (1972) coined the term "statistical discrimination" to describe the labor market disparities that would result from an employer having a harder time assessing the productivities of black as compared to white workers. In an earlier paper (Balsa and McGuire, 2001), we applied some of these insights originating in labor economics to a health care context. In the second application, which we call the "Rational Profiling" model, the doctor's ability to communicate with black patients is as good as his ability to communicate with white patients.…”

Section: Clinical Uncertaintymentioning

confidence: 99%

“…Even though Blacks might in some circumstances get more treatment with a noisy signal, it is still a mismatch of treatment to need. See Balsa and McGuire (2001) for further consideration of this issue. Fig.…”

Section: Miscommunication Leads To Disparitiesmentioning

confidence: 99%

“…The model above can be easily extended to include a search cost of treatment that varies across patients. With such a cost, Blacks will go less to the doctor or comply less with treatment recommendations than Whites because they expect lower benefits from treatment (Balsa and McGuire, 2001). …”

Section: Miscommunication Leads To Disparitiesmentioning

confidence: 99%

“…A complete study of the sources of clinical disparities should include attention to these patient-side explanations. 4 Our earlier paper, Balsa and McGuire (2001) analyzed the implications of greater uncertainty in doctors' interpretations of signals from minority patients and showed how this greater uncertainty can generate disparities. In the current paper we extend this analysis of decision-making under uncertainty to show that even when the degree of uncertainty is the same, differences in prior beliefs (even if these are accurate) can also cause disparities.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Prejudice, clinical uncertainty and stereotyping as sources of health disparities

Balsa

McGuire

2003

Journal of Health Economics

268

194

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Section: Introductionmentioning

confidence: 87%

Section: Clinical Uncertaintymentioning

confidence: 99%

Section: Miscommunication Leads To Disparitiesmentioning

confidence: 99%

Section: Miscommunication Leads To Disparitiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prejudice, clinical uncertainty and stereotyping as sources of health disparities

Balsa

McGuire

2003

Journal of Health Economics

268

194

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Diagnostic Patterns in Latino, African American, and European American Psychiatric Patients

Minsky¹,

Vega²,

Miskimen³

et al. 2003

Arch Gen Psychiatry

260

122

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Background: The purpose of this study was to examine whether Latino patients presenting for behavioral health treatment showed major systematic differences in presenting symptoms, clinical severity, and psychiatric diagnosis compared with European American and African American patients. Documenting such differences should have important implications for evidence-based clinical practice. Methods: Data were drawn from a large behavioral health service delivery system in New Jersey, and included administrative data, clinical diagnosis, a clinician-rated global level of functioning, and a self-reported symptoms and functioning scale. The study involved a clinical sample of all new admissions into the system between January 1, 2000, and August 31, 2001. To examine the main effects of ethnicity, in the context of other independent variables, logistic regression was performed for each of 3 dependent binary variables: presence or absence of major depression, a schizophrenia spectrum disorder, and bipolar disorder. Results: Consistent with previous studies, we found that African Americans were diagnosed as having a disorder SERVICE USE AND DIAGNOSTIC DISPARITIES Public policy considerations and standards of care require that all ethnic groups have access to behavioral health care, and that the same criteria are applied to their diagnostic assessment and treatment. However, prior research has revealed differential use patterns and diagnostic disparities in African Americans. Based at least on anecdotal information, it has been suggested that Latinos also share these disparities. Evidence regarding patterns of use, diagnosis, and self-reported symptom severity by Latinos has been scant and sometimes conflicting. Recent research 2,3 documents that African Americans and Latinos are underrepresented in mental health service systems across the nation, compared with European Americans. While epidemiological studies 4-7 show that individuals in the general population are not likely to receive mental health treatment even when

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Hospital Teaching Intensity, Patient Race, and Surgical Outcomes

Silber

Rosenbaum²,

Romano³

et al. 2009

Arch Surg

113

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Objectives To determine if the lower mortality often observed in teaching-intensive hospitals is due to lower complication rates or lower death rates after complications (failure-to-rescue), and whether the benefits at these hospitals accrue equally to white and black patients, since blacks receive a disproportionate share of their care at teaching-intensive hospitals. Design A retrospective study of patient outcomes and teaching intensity using logistic regression models, with and without adjusting for hospital fixed and random effects. Main Outcome Measures 30-day mortality, in-hospital complications and failure-to-rescue (“FTR”, the probability of death following complications). Setting 3,270 acute care hospitals in the United States. Patients Medicare claims on general, orthopedic and vascular surgery admissions in the U.S. for 2000 – 2005 (N = 4,658,954 unique patients). Results Combining all surgeries, compared to non-teaching hospitals, patients at very major teaching hospitals demonstrated a 15% lower odds of death (P<0.0001), no difference in complications, and a 15% lower odds of death after complications (FTR) (P<0.0001). These relative benefits associated with higher RB ratio were not experienced by black patients, for whom the odds of mortality and FTR are similar at teaching and non-teaching hospitals, a pattern that is significantly different from that of white patients (P<0.0001). Conclusions Survival after surgery is higher at hospitals with higher teaching intensity. Improved survival is due to lower mortality after complications (better FTR), and generally not due to fewer complications. However, this better survival and FTR at teaching intensive hospitals is seen for whites, not for blacks.

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Statistical discrimination in health care

Cited by 149 publications

References 56 publications

Prejudice, clinical uncertainty and stereotyping as sources of health disparities

Prejudice, clinical uncertainty and stereotyping as sources of health disparities

Diagnostic Patterns in Latino, African American, and European American Psychiatric Patients

Hospital Teaching Intensity, Patient Race, and Surgical Outcomes

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