Access to Care, Provider Choice and Racial Disparities

52 Pages Posted: 10 May 2004 Last revised: 18 Jul 2010

See all articles by Anna Aizer

Anna Aizer

Brown University - Department of Economics; National Bureau of Economic Research (NBER)

Adriana Lleras-Muney

Princeton University - Woodrow Wilson School of Public and International Affairs; National Bureau of Economic Research (NBER)

Mark Stabile

INSEAD; National Bureau of Economic Research (NBER)

Date Written: April 2004

Abstract

This paper explores whether choice of provider explains any of the observed infant health gradients, and if so, why poor women choose different providers than their richer neighbors. We exploit an exogenous change in policy that occurred in California in the early 1990s that suddenly increased Medicaid payments to hospitals and which lead to a sharp change in where women with Medicaid delivered. To characterize the extent to which poor women responded to the increase in provider access, we calculate hospital segregation indices (which measure the extent to which Medicaid mothers delivered in separate hospitals than privately insured mothers residing in the same geographic area) both before and after the policy change for each market in California and show that it fell sharply after the policy change. Even though black mothers responded least to the increase in provider choice afforded by the policy change, they benefited the most from hospital desegregation in terms of reduced neonatal mortality and decreased incidence of very low birth weight. In contrast, other groups with lower initial neonatal mortality moved more and gained less in terms of improvements in birth outcomes.

Suggested Citation

Aizer, Anna and Lleras-Muney, Adriana and Stabile, Mark, Access to Care, Provider Choice and Racial Disparities (April 2004). NBER Working Paper No. w10445. Available at SSRN: https://ssrn.com/abstract=533004

Anna Aizer

Brown University - Department of Economics ( email )

64 Waterman Street
Providence, RI 02912
United States
401-863-3836 (Phone)

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Adriana Lleras-Muney (Contact Author)

Princeton University - Woodrow Wilson School of Public and International Affairs ( email )

Princeton University
Princeton, NJ 08544-1021
United States

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Mark Stabile

INSEAD ( email )

Boulevard de Constance
F-77305 Fontainebleau Cedex
France

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

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