Racial and Ethnic Segregation in Nursing Homes


In this presentation, we discuss our upcoming contribution to the literature measuring and understanding drivers of racial and ethnic sorting (segregation) in the health care setting by constructing dissimilarity indices (DI) for nursing homes. The dissimilarity index, a commonly used measure in residential segregation studies, ranges from 0 to 1 and in our context describes the share of patients in a health care market who would have to switch homes in order for there to be evenness (no segregation) across the providers in that market. Prior work has computed the DI in healthcare settings but provides limited evidence on how the DI varies across geographic areas and/or is based on data more than a decade old. We combine administrative data on all certified nursing homes in the U.S. with health assessments of long-term stay patients residing in those homes for the years 2011 and 2017. Geographically, we define a nursing home market to be a county.

Our work contributes first to measurement of levels and trends: we provide updated measures of Black-white dissimilarity in nursing home care and show how it has changed during 2011-2017, and provide what we believe to be the first estimates of dissimilarity between Hispanics and whites in the nursing home setting. We next consider correlates of nursing home DIs to explore potential drivers: we find that residential DIs within the same communities tend to be lower than nursing home DIs, and we find that the DI is higher in counties with high income inequality, and in counties with nursing homes that are less reliant on Medicaid, with remarkable geographic variation. In every setting, the DI is lowest in parts of the country where the Black or Hispanic population is large, respectively. In later iterations of this work, we plan to examine causal impacts of relevant healthcare policies, such as payment and information reforms, on nursing home DIs.

Bowblis, John, Megdalynn Fisher, and Kosali Simon. “Racial and Ethnic Segregation in Nursing Homes” Oral presentation at the Midwest Health Economics Conference, DePaul University, Chicago, Illinois, September 8, 2023.