The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap
In 1966, Southern hospitals were barred from participating in the Medicare program unless they discontinued their long-standing practice of racial segregation. Using data from five Deep South states and exploiting county-level variation in Medicare certification dates, we find that gaining access to an ostensibly integrated hospital had no effect on the Black-White infant mortality gap, although it may have discouraged small numbers of Black mothers from giving birth at home attended by a midwife. These results are consistent with descriptions of the federal hospital desegregation campaign as producing only cosmetic changes and illustrate the limits of anti-discrimination policies imposed upon reluctant actors.
We thank Kenneth Chay, Ellora Derenoncourt, Rob Fleck, Michael Greenstone, Andy Hanssen, Damon Jones, Matt Notowidigdo, and seminar participants at the Center for Health Economics and Policy Studies at San Diego State University for their comments and suggestions. We also thank Joahn Borstell and Rafael Jarpa at the Louisiana Department of Health and Hospitals, Dick Johnson at the Mississippi State Department of Health, and Dawn Mullin at the South Carolina State Library for their help with obtaining state vital statistics records. Michael McKelligott and Andie Creel provided exceptional research assistance. Partial support for this research came from a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure grant, R24 HD042828, to the Center for Studies in Demography and Ecology at the University of Washington. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.