Racial and Payer Differences in Hospital Obstetric Care: Does Competition Matter?

Jeanette W. Chung, Princeton University

Racial differences in access to, and utilization of health care in the U.S. have been extensively documented empirically. Researchers have ascribed these disparities to a number of sources, including group differences in socioeconomic status, acculturation, and health status. However, few have considered the role of market competition on social disparities in health care. In this paper, we use hospital discharge data from California to examine the effects of competition on race and payer differences among delivering women in rates of three common obstetric procedures: medical induction of labor, artificial rupture of membranes, and episiotomy . Preliminary analyses suggest that although White women are more likely than Black, Hispanic, or Asian women to undergo each of these procedures, competition does not appear to affect the magnitude of these disparities. However, a greater degree market competition does appear to exacerbate payer differences in rates of these obstetric interventions.