Identifying Provider Prejudice in Healthcare

45 Pages Posted: 27 Sep 2010 Last revised: 17 Oct 2010

See all articles by Amitabh Chandra

Amitabh Chandra

Harvard University - Harvard Kennedy School (HKS); National Bureau of Economic Research (NBER); IZA Institute of Labor Economics

Douglas Staiger

Dartmouth College - Department of Economics; National Bureau of Economic Research (NBER)

Date Written: September 2010

Abstract

We use simple economic insights to develop a framework for distinguishing between prejudice and statistical discrimination using observational data. We focus our inquiry on the enormous literature in healthcare where treatment disparities by race and gender are not explained by access, preferences, or severity. But treatment disparities, by themselves, cannot distinguish between two competing views of provider behavior. Physicians may consciously or unconsciously withhold treatment from minority groups despite similar benefits (prejudice) or because race and gender are associated with lower benefit from treatment (statistical discrimination). We demonstrate that these two views can only be distinguished using data on patient outcomes: for patients with the same propensity to be treated, prejudice implies a higher return from treatment for treated minorities, while statistical discrimination implies that returns are equalized. Using data on heart attack treatments, we do not find empirical support for prejudice-based explanations. Despite receiving less treatment, women and blacks receive slightly lower benefits from treatment, perhaps due to higher stroke risk, delays in seeking care, and providers over-treating minorities due to equity and liability concerns.

Suggested Citation

Chandra, Amitabh and Staiger, Douglas, Identifying Provider Prejudice in Healthcare (September 2010). NBER Working Paper No. w16382. Available at SSRN: https://ssrn.com/abstract=1683132

Amitabh Chandra (Contact Author)

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

IZA Institute of Labor Economics

P.O. Box 7240
Bonn, D-53072
Germany

Douglas Staiger

Dartmouth College - Department of Economics ( email )

Hanover, NH 03755
United States
603-643-2979 (Phone)

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

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