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首页> 外文期刊>Atlantic economic journal >Race, Quality of Care and Patient Outcomes: What Can We Learn from the Department of Veterans Affairs?
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Race, Quality of Care and Patient Outcomes: What Can We Learn from the Department of Veterans Affairs?

机译：种族，护理质量和患者结果：我们可以从退伍军人事务部那里学到什么？

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摘要

The large and persistent differences in health outcomes between African Americans and whites have sometimes been attributed to differences in the quality of the facilities in which they receive care. A large body of literature documents systematically worse performance by facilities which serve a larger share of black patients. However, these estimates may be biased by unobserved variables which correlate with the racial profile of the clinic and also affect outcomes. This paper uses a unique dataset from the Department of Veterans' Affairs system to examine the relationship between the quality of health care and the racial profile of the patient population in an equal-access health care system. An instrumental variable is used to overcome the omitted variable bias in the Ordinary Least Squares (OLS) estimates. Both the OLS and IV estimates show that increasing the proportion of visits by African-American patients results in improved outcomes for all patients treated at the clinic. The OLS results significantly underestimate the effect of increasing the proportion of black patients. Holding the overall clinic load constant and adding one hundred outpatient visits by African Americans in a year would result in a 0.5 percentage point decrease in 1-year mortality for the average patient in the clinic. Thus, contrary to results from the private health care sector, increasing clinic racial integration in an equal access system would benefit all patients.
机译：非裔美国人和白人之间在健康结果方面的巨大而持久的差异有时归因于他们所接受医疗设施的质量差异。大量文献记录了服务于更多黑人患者的设施的系统性能下降。但是，这些估计值可能会因未观察到的变量而有偏差，这些变量与诊所的种族状况相关，并且还会影响结果。本文使用了来自退伍军人事务部系统的唯一数据集，以研究在平等访问医疗系统中医疗质量与患者群体种族特征之间的关系。工具变量用于克服普通最小二乘（OLS）估计中省略的变量偏差。 OLS和IV估计均显示，非裔美国人患者就诊比例的增加导致所有在诊所接受治疗的患者的结局均得到改善。 OLS结果大大低估了增加黑人患者比例的效果。保持诊所的整体负荷不变，并在一年中增加100名非裔美国人的门诊服务，将使该诊所普通患者的1年死亡率降低0.5个百分点。因此，与私人保健部门的结果相反，在平等获取系统中增加诊所种族融合将使所有患者受益。

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