Christian Peraza

(medical student at UCLA)

Picture of Yagmur Muftuoglu, MD, PhD

Yagmur Muftuoglu, MD, PhD

(CANS fellow)

Socioeconomic Journal Club

Racial segregation in healthcare persists as a significant issue impacting minority populations, resulting in unequal treatment, diminished health outcomes, and heightened medical mistrust. The systemic separation of healthcare services and facilities based on race contributes to increased disease prevalence and elevated mortality rates within these minority populations. The lack of access to necessary treatment and medical care further increases their disadvantage, posing challenges for disease prevention and management.

In the article, researchers explore how racial segregation in hospital admissions among Medicare beneficiaries impacts health disparities. The study aims to understand the distribution of patients from different racial backgrounds among hospitals within the same healthcare market and the disparities in access to care based on residential location.

The researchers developed a novel Local Hospital Segregation (LHS) index to measure whether a hospital’s racial pattern of admission significantly differs from the racial composition of its surrounding area. Using Medicare data, they assessed hospitalizations across various racial and ethnic groups, including American Indian or Alaska Native, Hispanic, Black, Asian, and Non-Hispanic White patients.

The study found significant disparities, with 79.4% of hospitals showing racial admission patterns that differed from their market, indicating that hospitals often do not reflect the diversity of their communities. Key findings revealed that among 1,991 hospitals, approximately 34% had a negative Local Hospital Segregation (LHS) index, indicating fewer Black patients were admitted compared to their hospital market, while 45% had a positive LHS index, admitting more Black patients. Both indices highlight systemic issues of racial segregation in healthcare. A positive LHS index might have two interpretations. It proposes that certain hospitals are more accessible and inclusive; however, it may also indicate that other hospitals in the market are failing to adequately serve Black patients, leading to a higher concentration of patients in specific hospitals that do provide the necessary care. Conversely, a negative LHS index reflects underrepresentation of Black patients, potentially resulting in reduced access to quality care and poorer health outcomes. The analysis also highlighted significant associations between the LHS index and hospital characteristics such as teaching status, for-profit status, and disproportionate-share hospital (DSH) status.

By identifying and assessing racial segregation in hospital admissions at the local level, the LHS index sheds light on the issues surrounding racial disparities in healthcare. These insights are essential for shaping policies and practices aimed at increasing inclusivity and diversity within healthcare settings. Gaining a deeper understanding of the factors that influence patient distribution can help establish more equitable healthcare environments and improve access to high-quality care for everyone, especially those in marginalized communities.

Anthony DiGiorgio DO MHA (CANS Newsletter Editor)

This study presents a novel index, the Local Hospital Segregation (LHS), to attempt to measure segregation in US hospital markets. This is enlightening but raises more questions than it provides answers. On first glance, it may seem that there is discrimination against Black patients given that nearly 80% of hospitals have admission proportions that differ from the local population. However, this is largely because many hospitals are MORE open to admitting Black patients.

Which begs the question: what is the RIGHT proportion of admissions? Should it match the local population exactly? People are independent with their own preferences for different establishments. We don’t know why one group chooses one institution over another, but assuming they will evenly distribute as if randomly assigned is unrealistic. Their preferences will reveal themselves in hospital choice, similar to other establishments. It’s doubtful that patronage of every restaurant, grocery store, car dealership, and school perfectly matches the local population’s racial breakdown. As Thomas Sowell eloquently demonstrates, disparity in itself does not indicate discrimination. While the LHS is interesting, let’s keep that fact in mind.