[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/a/ucp/amjhec/v5y2019i4p407-427.html
   My bibliography  Save this article

Discrimination in Health Care: A Field Experiment on the Impact of Patients’ Socioeconomic Status on Access to Care

Author

Listed:
  • Silvia Angerer

    (UMIT—Private University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare)

  • Christian Waibel

    (ETH Zurich)

  • Harald Stummer

    (UMIT—Private University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, University Seeburg Castle, Institut für Gesundheitsmanagement und Innovation)

Abstract
We employ a large-scale field experiment to investigate the impact of patients’ socioeconomic status on access to care. We request an appointment at more than 1,200 physicians in Austria, varying the educational level of the patient. Our results show that overall patients with a university degree receive an appointment significantly more often than patients without a degree. Differentiating between practice assistants and physicians as responders, we find that physicians provide significantly shorter response times and marginally significant shorter waiting times for appointments for patients with than without a university degree. Our results thus provide unambiguous evidence that discrimination by health providers contributes to the gradient in access to care. Furthermore, we argue that our results are consistent with implicit bias for practice assistants and statistical discrimination based on financial incentives for physicians.

Suggested Citation

  • Silvia Angerer & Christian Waibel & Harald Stummer, 2019. "Discrimination in Health Care: A Field Experiment on the Impact of Patients’ Socioeconomic Status on Access to Care," American Journal of Health Economics, University of Chicago Press, vol. 5(4), pages 407-427, Fall.
    • Handle: RePEc:ucp:amjhec:v:5:y:2019:i:4:p:407-427
    as

    Download full text from publisher

    File URL: https://www.journals.uchicago.edu/doi/pdf/10.1162/ajhe_a_00124
    Download Restriction: Access to PDF is restricted to subscribers.
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Lee, Chung H & Warren, E H, Jr, 1976. "Rationing by Seller's Preference and Racial Price Discrimination," Economic Inquiry, Western Economic Association International, vol. 14(1), pages 36-44, March.
    2. Kerwin Kofi Charles & Jonathan Guryan, 2011. "Studying Discrimination: Fundamental Challenges and Recent Progress," Annual Review of Economics, Annual Reviews, vol. 3(1), pages 479-511, September.
    3. Laudicella, Mauro & Siciliani, Luigi & Cookson, Richard, 2012. "Waiting times and socioeconomic status: Evidence from England," Social Science & Medicine, Elsevier, vol. 74(9), pages 1331-1341.
    4. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Cookson, Richard, 2018. "Socioeconomic inequality of access to healthcare: Does choice explain the gradient?," Journal of Health Economics, Elsevier, vol. 57(C), pages 290-314.
    5. Charness, Gary & Gneezy, Uri & Kuhn, Michael A., 2012. "Experimental methods: Between-subject and within-subject design," Journal of Economic Behavior & Organization, Elsevier, vol. 81(1), pages 1-8.
    6. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    7. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
    8. Johar, Meliyanni & Jones, Glenn & Keane, Micheal P. & Savage, Elizabeth & Stavrunova, Olena, 2013. "Discrimination in a universal health system: Explaining socioeconomic waiting time gaps," Journal of Health Economics, Elsevier, vol. 32(1), pages 181-194.
    9. Marianne Bertrand & Dolly Chugh & Sendhil Mullainathan, 2005. "Implicit Discrimination," American Economic Review, American Economic Association, vol. 95(2), pages 94-98, May.
    10. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    11. James J. Heckman, 1998. "Detecting Discrimination," Journal of Economic Perspectives, American Economic Association, vol. 12(2), pages 101-116, Spring.
    12. Patrick Peretti-Watel & Olivier L’haridon & Valérie Seror, 2013. "Time preferences, socioeconomic status and smokers' behaviour, attitudes and risk awareness," Post-Print halshs-00801330, HAL.
    13. Jonathan Guryan & Kerwin Kofi Charles, 2013. "Taste‐based or Statistical Discrimination: The Economics of Discrimination Returns to its Roots," Economic Journal, Royal Economic Society, vol. 123(11), pages 417-432, November.
    14. Oddvar Kaarboe & Fredrik Carlsen, 2014. "Waiting Times And Socioeconomic Status. Evidence From Norway," Health Economics, John Wiley & Sons, Ltd., vol. 23(1), pages 93-107, January.
    15. Courant, Paul N., 1978. "Racial prejudice in a search model of the urban housing market," Journal of Urban Economics, Elsevier, vol. 5(3), pages 329-345, July.
    16. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July.
    17. Marianne Bertrand & Sendhil Mullainathan, 2004. "Are Emily and Greg More Employable Than Lakisha and Jamal? A Field Experiment on Labor Market Discrimination," American Economic Review, American Economic Association, vol. 94(4), pages 991-1013, September.
    18. Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), 2011. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, volume 2, number 2.
    19. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding differences in health behaviors by education," Journal of Health Economics, Elsevier, vol. 29(1), pages 1-28, January.
    20. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
    21. Castillo, Marco & Ferraro, Paul J. & Jordan, Jeffrey L. & Petrie, Ragan, 2011. "The today and tomorrow of kids: Time preferences and educational outcomes of children," Journal of Public Economics, Elsevier, vol. 95(11), pages 1377-1385.
    22. Karin Monstad & Lars Birger Engesæter & Birgitte Espehaug, 2014. "Waiting Time And Socioeconomic Status—An Individual‐Level Analysis," Health Economics, John Wiley & Sons, Ltd., vol. 23(4), pages 446-461, April.
    23. Sharma, Anurag & Siciliani, Luigi & Harris, Anthony, 2013. "Waiting times and socioeconomic status: Does sample selection matter?," Economic Modelling, Elsevier, vol. 33(C), pages 659-667.
    24. Kerwin Kofi Charles & Jonathan Guryan, 2008. "Prejudice and Wages: An Empirical Assessment of Becker's The Economics of Discrimination," Journal of Political Economy, University of Chicago Press, vol. 116(5), pages 773-809, October.
    25. Phelps, Edmund S, 1972. "The Statistical Theory of Racism and Sexism," American Economic Review, American Economic Association, vol. 62(4), pages 659-661, September.
    26. Luigi Siciliani & Rossella Verzulli, 2009. "Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1295-1306, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Halla, Martin & Kah, Christopher & Sausgruber, Rupert, 2021. "Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany," Department of Economics Working Paper Series 319, WU Vienna University of Economics and Business.
    2. Rita Ginja & Julie Riise & Barton Willage & Alexander L.P. Willén, 2022. "Does Your Doctor Matter? Doctor Quality and Patient Outcomes," CESifo Working Paper Series 9788, CESifo.
    3. Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.
    4. Black, Nicole & Johnston, David W. & Shields, Michael A. & Trinh, Trong-Anh, 2024. "Inequity in Child Mental Healthcare Use," IZA Discussion Papers 17409, Institute of Labor Economics (IZA).
    5. Currie, Janet & Kurdyak, Paul & Zhang, Jonathan, 2024. "Socioeconomic status and access to mental health care: The case of psychiatric medications for children in Ontario Canada," Journal of Health Economics, Elsevier, vol. 93(C).
    6. Luca Fumarco & Benjamin Harrell & Patrick Button & David Schwegman & E Dils, 2020. "Gender Identity, Race, and Ethnicity-based Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment," NBER Working Papers 28164, National Bureau of Economic Research, Inc.
    7. Sylvain Chareyron & Yannick L’Horty & Pascale Petit, 2023. "Cream skimming and discrimination in access to medical care: A field experiment," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1868-1883, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jakobsson, Niklas & Kotsadam, Andreas & Syse, Astri & Øien, Henning, 2016. "Gender bias in public long-term care? A survey experiment among care managers," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 126-138.
    2. Nicolai Fink Simonsen & Anne Sophie Oxholm & Søren Rud Kristensen & Luigi Siciliani, 2020. "What explains differences in waiting times for health care across socioeconomic status?," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1764-1785, December.
    3. Halla, Martin & Kah, Christopher & Sausgruber, Rupert, 2021. "Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany," Department of Economics Working Paper Series 319, WU Vienna University of Economics and Business.
    4. Laia Bosque‐Mercader & Neus Carrilero & Anna García‐Altés & Guillem López‐Casasnovas & Luigi Siciliani, 2023. "Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain," Health Economics, John Wiley & Sons, Ltd., vol. 32(5), pages 1181-1201, May.
    5. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Cookson, Richard, 2018. "Socioeconomic inequality of access to healthcare: Does choice explain the gradient?," Journal of Health Economics, Elsevier, vol. 57(C), pages 290-314.
    6. Turner, Alex J & Francetic, Igor & Watkinson, Ruth & Gillibrand, Stephanie & Sutton, Matt, 2022. "Socioeconomic inequality in access to timely and appropriate care in emergency departments," Journal of Health Economics, Elsevier, vol. 85(C).
    7. Ewens, Michael, 2022. "Race and Gender in Entrepreneurial Finance," SocArXiv djf8z, Center for Open Science.
    8. Eric French & Elaine Kelly & Richard Cookson & Carol Propper & Miqdad Asaria & Rosalind Raine, 2016. "Socio‐Economic Inequalities in Health Care in England," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 371-403, September.
    9. Morten Størling Hedegaard & Jean-Robert Tyran, 2018. "The Price of Prejudice," American Economic Journal: Applied Economics, American Economic Association, vol. 10(1), pages 40-63, January.
    10. Marianne Bertrand & Esther Duflo, 2016. "Field Experiments on Discrimination," NBER Working Papers 22014, National Bureau of Economic Research, Inc.
    11. Kevin Lang & Jee-Yeon K. Lehmann, 2012. "Racial Discrimination in the Labor Market: Theory and Empirics," Journal of Economic Literature, American Economic Association, vol. 50(4), pages 959-1006, December.
    12. Martin, Steve & Siciliani, Luigi & Smith, Peter, 2020. "Socioeconomic inequalities in waiting times for primary care across ten OECD countries," Social Science & Medicine, Elsevier, vol. 263(C).
    13. Marianne Bertrand & Esther Duflo, 2016. "Field Experiments on Discrimination," NBER Working Papers 22014, National Bureau of Economic Research, Inc.
    14. Landi, Stefano & Ivaldi, Enrico & Testi, Angela, 2018. "Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System," Health Policy, Elsevier, vol. 122(4), pages 334-351.
    15. Chowdhury, Shyamal & Ooi, Evarn & Slonim, Robert, 2017. "Racial discrimination and white first name adoption: a field experiment in the Australian labour market," Working Papers 2017-15, University of Sydney, School of Economics.
    16. Button, Patrick & Walker, Brigham, 2020. "Employment discrimination against Indigenous Peoples in the United States: Evidence from a field experiment," Labour Economics, Elsevier, vol. 65(C).
    17. Castillo, Marco & Petrie, Ragan & Torero, Maximo & Vesterlund, Lise, 2013. "Gender differences in bargaining outcomes: A field experiment on discrimination," Journal of Public Economics, Elsevier, vol. 99(C), pages 35-48.
    18. Wen, Jinglin & Santos, Rita & Siciliani, Luigi & Proctor, Andrew, 2024. "Socioeconomic inequalities in hospital access for prostate cancer before and after COVID-19," Socio-Economic Planning Sciences, Elsevier, vol. 94(C).
    19. Gutacker, Nils & Siciliani, Luigi & Cookson, Richard, 2016. "Waiting time prioritisation: Evidence from England," Social Science & Medicine, Elsevier, vol. 159(C), pages 140-151.
    20. John M. Nunley & Mark F. Owens & R. Stephen Howard, 2010. "The Effects of Competition and Information on Racial Discrimination: Evidence from a Field Experiment," Working Papers 201007, Middle Tennessee State University, Department of Economics and Finance.

    More about this item

    Keywords

    access to health care; SES health gradient; discrimination; field experiment;
    All these keywords.

    JEL classification:

    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ucp:amjhec:v:5:y:2019:i:4:p:407-427. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Journals Division (email available below). General contact details of provider: https://www.journals.uchicago.edu/AJHE .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.