Purchase Print Copy

 FormatList Price
Add to Cart Paperback6 pages Free

This study analyzes whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. The authors compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes. The study looked at patients 65 years of age or older who lived at home prior to hospitalization for congestive heart failure, acute myocardial infarction, pneumonia, or stroke. It took place at acute care hospitals in 30 areas within five states. The authors found that within rural, urban nonteaching, and urban teaching hospitals, patients who are black or from poor neighborhoods have worse processes of care and greater instability at discharge than other patients. However, this worse quality is offset by patients who are black or from poor neighborhoods being 1.8 times more likely to receive care in urban teaching hospitals that have been shown to provide better quality of care. Because these patients receive more of their care in better-quality hospitals, there are not overall differences in quality by race and poverty status. Death rate did not vary by race or poverty status. The authors conclude that quality of hospital care for insured Medicare patients is influenced both by the patient's race and financial characteristics and by the hospital type in which the patient receives care.

Originally published in: Journal of the American Medical Association, v. 271, no. 15, April 20, 1994, pp. 1169-1174.

This report is part of the RAND Corporation reprint series. The Reprint was a product of the RAND Corporation from 1992 to 2011 that represented previously published journal articles, book chapters, and reports with the permission of the publisher. RAND reprints were formally reviewed in accordance with the publisher's editorial policy and compliant with RAND's rigorous quality assurance standards for quality and objectivity. For select current RAND journal articles, see External Publications.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.