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Black-White Disparities in Care in Nursing Homes

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Abstract

Nursing homes serve many severely ill poor people, including large numbers of racial/ethnic minority residents. Previous research indicates that blacks tend to receive care from lower quality nursing homes. Using the Institute of Medicine (IOM) definition of racial-ethnic disparities, this study decomposes nursing home disparities into within and across facility components. Using detailed person-level nursing home data, we find meaningful black-white disparities for one of the four risk-adjusted quality measures, with both within and across nursing home components of the disparity. The IOM approach, which recognizes mediation through payer status and education, has a small effect on measured disparities in this setting. Although we did not find disparities across the majority of quality measures and alternate disparity definitions, this approach can be applied to other health care services in an effort to disentangle the role of across and within facility variation and the role of potential mediators on racial/ethnic disparities.

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Notes

  1. For discussion of some of the conceptual issues associated with application of the IOM definition, including the problematic role of “preferences,” see McGuire et al. (2006).

  2. The most prominent example of the first definition are the National Healthcare Disparities Reports produced by the Agency for Healthcare Quality and Research (AHRQ 2007). Although these comprehensive and valuable reports take different approaches to disparities measurement depending on the subject, most of the group comparisons are unadjusted means. The disparities literature is filled with papers focusing on the race coefficient—the second definition—within a model of health care use.

  3. See Fairlie (2006) for discussion of similar issues in a nonlinear context.

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Acknowledgement

Research for this article was supported by grants K01 AG024403 from the National Institute of Aging, P60 MD002261 from the National Center for Minority Health and Health Disparities, and P50 MH073469 from the National Institute of Mental Health. These data were accessed under CMS data use agreement number 15989. We are grateful to Linda Dynan for helpful comments on an earlier draft.

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Correspondence to David C. Grabowski.

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Grabowski, D.C., McGuire, T.G. Black-White Disparities in Care in Nursing Homes. Atl Econ J 37, 299–314 (2009). https://doi.org/10.1007/s11293-009-9185-7

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  • DOI: https://doi.org/10.1007/s11293-009-9185-7

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