A new study from Justin Dimick and colleagues appearing in the June issue of Health Affairs builds on the established evidence that blacks are more likely than whites to have surgery at low-quality hospitals, but adds an interesting twist: the degree of racial segregation in an area–and not distance to the nearest hospital–is what matters.
In fact, the authors find that black patients actually lived closer to the high quality hospitals than white patients did. So this isn’t about convenience based on proximity, and it isn’t about segregating in such a way that the low-quality hospitals and the minority neighborhoods are lumped together geographically. Instead, it is about something much more systemic: residential segregation. In other words, if the black and white residents of your community are spread around pretty evenly, then blacks aren’t having surgery in low-quality hospitals quite as often. If, on the other hand, blacks and whites live on different sides of town in your community, then this study finds that black patients are up to 96% more likely than whites to have surgery in a low-quality hospital. In their paper, the authors suggest ways of reducing these disparities, but also conclude that current payment reforms, including pay-for-performance, may actually exacerbate the disparities by further diverting resources away from the low-quality hospitals.