Rationing by Race

We hypothesize that deepening resource scarcity results in rationing on the basis of group identity in settings with underlying discrimination. We provide evidence of such race-based rationing in a high-stakes setting: health care. Using detailed, time-stamped data on 107,000 patient admissions to a large health system, we find that in-hospital mortality increases for Black, but not White, patients as hospitals reach capacity (a state of resource scarcity likely to trigger or exacerbate biases in decision-making). As a mechanism, we identify rationing by wait time, documenting that sick Black patients wait longer for care than healthy White patients at every capacity level, likely because of systematic misevaluation of medical need. Text analysis of unstructured provider notes reveals differential rationing of provider effort by race as another potential mechanism. Together, these findings demonstrate important linkages between three key economic concepts: scarcity, discrimination, and rationing.