Racial and Ethnic Disparities in Maternal Treatment and Death: Evaluating the Role of Hospital and Physician Effects

Abstract

Past work has documented disparities in medical treatment and health outcomes across racial and ethnic groups.  In some instances, disparities persist beyond individual health risk factors and reveal underlying differences in the hospital facilities or the attending physicians that different patients tend to go to.  In the case of maternal mortality and cesarean delivery, not only does the U.S. perform poorly on both measures, but also there exist racial and ethnic disparities in maternal treatment that lead to disadvantaged outcomes for vulnerable populations.  By separately absorbing hospital and physician fixed effects, the contribution of both facility and practitioner variation to the present health disparities can be identified.  Hospital variation maps to a significant portion of the racial disparity in cesarean delivery and the ethnic disparity in the induction of labor.  Controlling for physician fixed effects explains some portion of the racial disparities in maternal mortality and cesarean delivery, all of the ethnic disparity in cesarean delivery, and some of both disparities in the induction of labor.  These results suggest ample opportunities for targeted intervention to minimize the variation between physicians and hospitals in their approach to maternal care toward more equitable care provision.