Structural segregation in healthcare is leading many Black Medicare patients to be disproportionately admitted to lower-quality hospitals despite living near high-quality facilities, a Johns Hopkins study found.
The study, published Dec. 5 in PLOS One, used 2019 Medicare claims data from more than 2,000 hospitals. The team used the data to develop the Local Hospital Segregation index, a metric that measures how much a hospital’s share of admissions for a racial group differs from the group’s share among all patients admitted to any hospital in the surrounding market area. The index uses statistical modeling, adjusted for residential segregation, ownership, teaching status, Medicare Disproportionate Share Hospital status, market size and region.
Here are three study findings:
1. The study found Black Medicare patients had a 79% higher likelihood to be admitted to a 1- or 2-star hospital under the CMS quality rating system.
2. It also found residential segregation alone did not account for unequal access to high-quality healthcare.
3. The disparity was consistent among Medicare beneficiaries who have similar coverage and provider access.
“What we are seeing is segregation within the healthcare system itself — a sorting of patients of different races, in seen and unseen ways, even within the same neighborhood,” Ellesse-Roselee Akré, PhD, assistant professor in health policy and management at Baltimore-based system, said in a Feb. 12 system news release. “Proximity to a high-quality hospital does not guarantee admission. To advance equity, we must examine the systems and incentives that guide where patients are directed.”
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