The Impact of Hospital Integration on Black-White Differences in Mortality: A Case Study of Motor Vehicle Accident Death Rates (Job Market Paper)

Prior to the Civil Rights Era hospitals in the American South could, and routinely did, refuse medical care to Black patients even in emergency situations. When in need of medical care a sick or injured African-American would have to find a “Blacks-only” facility, or face very limited accommodations in “Whites-only” institutions. This situation changed, however, in the mid-1960s when hospitals became racially integrated. This paper studies the impact of hospital integration on racial differences in deaths from motor vehicle accidents. Focusing primarily on Mississippi, I use detailed micro-data from the US Vital Statistics matched with race-specific hospital survey information from 1959-1978. Using GIS methods O compute a race-specific measure of distance to the nearest hospital before and after integration, which occurred in 1965. I find that, on average, distance to nearest hospital fell by 50 miles for blacks after integration. I also show that distance and accident mortality were positively correlated: increases in distance to the nearest hospital were associated with higher mortality. Combining the treatment effects of distance with integration, I conclude that hospital integration reduced African-American mortality from car accidents by 12 percent.

Surviving breast cancer in Boston: The impact of racial disparities in health care access

In the United States, breast cancer is the most common cancer among women. Although the incidence of breast cancer is higher among white than among black women, blacks suffer worse cancer outcome. Early detection of breast cancer requires medical intervention in the form of screening and clinical examination, as well as monitoring and follow-through on ambiguous findings. This paper studies how racial differences on medical access affect their survival from breast cancer. The data analyzed in the paper were collected at a hospital-based diagnostic breast health practice at a major academic medical center which is also the major safety net hospital in Boston in 2006-2007. Patients served include those who receive their primary care at the academic medical center and those from over 20 affiliated community health centers throughout Boston. Using GIS techniques I measure the distance from each patient’s home to the health centers. I show that, on average, black patients had to travel longer distances to obtain treatment. This finding highlights important features of medical access. Some of those disparities were driven by long-standing patterns of racial segregation in housing. But there are more profound forces at play beyond residential segregation. These involve the confluence of patient race, culture barriers, and health care financing.