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Racial segregation and quality of care disparity in US nursing homes

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  • Rahman, Momotazur
  • Foster, Andrew D.

Abstract

In this paper, we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality.

Suggested Citation

  • Rahman, Momotazur & Foster, Andrew D., 2015. "Racial segregation and quality of care disparity in US nursing homes," Journal of Health Economics, Elsevier, vol. 39(C), pages 1-16.
    • Handle: RePEc:eee:jhecon:v:39:y:2015:i:c:p:1-16
    DOI: 10.1016/j.jhealeco.2014.09.003
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    References listed on IDEAS

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    1. Bayer, Patrick & McMillan, Robert & Rueben, Kim S., 2004. "What drives racial segregation? New evidence using Census microdata," Journal of Urban Economics, Elsevier, vol. 56(3), pages 514-535, November.
    2. David Card & Alexandre Mas & Jesse Rothstein, 2008. "Tipping and the Dynamics of Segregation," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(1), pages 177-218.
    3. Gertler, Paul J, 1992. "Medicaid and the Cost of Improving Access to Nursing Home Care," The Review of Economics and Statistics, MIT Press, vol. 74(2), pages 338-345, May.
    4. Patrick Bayer & Robert McMillan, 2005. "Racial Sorting and Neighborhood Quality," NBER Working Papers 11813, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Cellini, Roberto & Siciliani, Luigi & Straume, Odd Rune, 2018. "A dynamic model of quality competition with endogenous prices," Journal of Economic Dynamics and Control, Elsevier, vol. 94(C), pages 190-206.
    2. Rahman, Momotazur & Norton, Edward C. & Grabowski, David C., 2016. "Do hospital-owned skilled nursing facilities provide better post-acute care quality?," Journal of Health Economics, Elsevier, vol. 50(C), pages 36-46.
    3. Beam, Emily A. & Shrestha, Slesh, 2016. "Inter-ethnic Fertility Spillovers and the Role of Forward-looking Behavior: Evidence from Peninsular Malaysia," IZA Discussion Papers 10385, Institute of Labor Economics (IZA).
    4. Cornell, Portia Y. & Grabowski, David C. & Norton, Edward C. & Rahman, Momotazur, 2019. "Do report cards predict future quality? The case of skilled nursing facilities," Journal of Health Economics, Elsevier, vol. 66(C), pages 208-221.

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    More about this item

    Keywords

    Race; Distance; Nursing home sorting; Segregation; Quality of care; Instrumental variable;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination

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