title: Explaining racial/ethnic disparities in use of high-volume hospitals: decision-making complexity and local hospital environments.
abstract: Racial/ethnic minorities are less likely to use higher-quality hospitals than whites. We propose that a higher level of information-related complexity in their local hospital environments compounds the effects of discrimination and more limited access to services, contributing to racial/ethnic disparities in hospital use. While minorities live closer than whites to high-volume hospitals, minorities also face greater choice complexity and live in neighborhoods with lower levels of medical experience. Our empirical results reveal that it is generally the overall context associated with proximity, choice complexity, and local experience, rather than differential sensitivity to these factors, that provides a partial explanation of the disparity gap in high-volume hospital use.
authors.affiliation: City University of New York, NY, USA Karl.Kronebusch@baruch.cuny.edu.
authors.forename: Karl
authors.initials: K
authors.lastname: Kronebusch
authors.affiliation: Urban Institute, Washington, DC, USA.
authors.forename: Bradford H
authors.initials: BH
authors.lastname: Gray
authors.affiliation: Yale University, New Haven, CT, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Schlesinger
mesh_terms: D003657:Decision Making; D005260:Female; D006272:Health Facility Environment; D006297:Health Services Accessibility; D006302:Health Services Research; D054625:Healthcare Disparities / Q000208:ethnology*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011287:Prejudice / Q000208:ethnology*; D044469:Racial Groups; D012111:Residence Characteristics; D014481:United States
keywords: behavioral economics; disparities; hospital choice; hospital volume and outcomes