Most U.S. Hospitals Admit Disproportionate Numbers of Black Medicare Patients, Study Finds

Johns Hopkins

April 23

A study analyzing Medicare admissions at nearly 2,000 acute care hospitals nationwide during 2019 found that most hospitals—nearly four out of five—admitted a significantly different proportion of Black fee-for-service Medicare patients age 65 and older compared to the proportion of the same group of patients admitted to any hospital in that hospital's market area. The researchers suggest that understanding hospital choices within neighborhoods and markets could help reduce racial inequities in health outcomes.

The study, published in JAMA Network Open, revealed that 34.4 percent of hospitals admitted significantly fewer Black patients relative to the surrounding hospital market, while 45.0 percent admitted significantly more. This racial sorting effect was found to be especially common in areas of the U.S. with large concentrations of Black residents.

Factors Beyond Residential Segregation Contribute to Racial Sorting

Study lead author Ellesse-Roselee Akré, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, states, "These findings tell us that there are other factors besides local residential segregation that cause the racial sorting of hospital patients. The next question is how might this differential sorting influence health outcomes and racial inequities."

The researchers developed a measure called the Local Hospital Segregation index, which takes the percentage of a racial group in a given hospital's admissions and subtracts the percentage of that race in all hospital admissions in the surrounding area. This novel metric is thought to be the first to measure hospital segregation in hospital admissions within hospital markets.

Potential Impact on Racial Inequities in Health Outcomes

While the study did not examine the consequences of racial sorting, the researchers plan to investigate its impact on racial inequities in health outcomes. Hospitals that admit a disproportionate number of Black patients may have lower care quality, as some prior studies have found. The researchers aim to use their novel measure to examine the relationship between patient sorting and hospital quality using the Centers for Medicare & Medicaid Services' Overall Hospital Quality Star Rating.