Geography and Racial Health Disparities

An extensive literature has documented racial, ethnic, and socioeconomic disparities in health care and health outcomes. We argue that the influence of geography in medical practice needs to be taken seriously for both the statistical measurement of racial disparities, and in designing reforms to reduce disparities. Past research has called attention to disparities that occur within hospitals or provider groups; for example black patients who are treated differently from whites within a hospital. We focus on a different mechanism for disparities; African-Americans tend to live in areas or seek care in regions where quality levels for all patients, black and white, are lower. Thus ensuring equal access to health care at the local or hospital level may not by itself erase overall health care disparities. However, reducing geographic disparities in both the quality of care, and the quality of health care decisions by patients, could have a first-order impact on improving racial disparities in health care and health outcomes.