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The racial segregation of hospital care revisited: Medicare discharge patterns and their implications.

D B Smith

Department of Health Administration, School of Business and Management, Temple University, Philadelphia, Pa. 19122, USA.

OBJECTIVES: This paper measures current patterns of hospital segregation among Medicare beneficiaries. METHODS: Data from the fiscal year 1993 Medicare Provider Analysis and Review (MEDPAR) file, the index of dissimilarity, and a linear regression model are used to test the effects of standard metropolitan area characteristics on hospital segregation. RESULTS: The overall hospital segregation index was 0.529, ranging by state from 0.154 to 0.746. Hospital segregation in 126 standard metropolitan areas was positively related to population size, hospital density, and residential segregation and negatively related to income inequities and location in the South. CONCLUSIONS: Racial segregation remains high and may produce both reporting biases and unequal effects of public policy.

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