Atlantic Economic Journal

, Volume 37, Issue 3, pp 299-314

First online:

Black-White Disparities in Care in Nursing Homes

  • David C. GrabowskiAffiliated withDepartment of Health Care Policy, Harvard Medical School Email author 
  • , Thomas G. McGuireAffiliated withDepartment of Health Care Policy, Harvard Medical School

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access


Nursing homes serve many severely ill poor people, including large numbers of racial/ethnic minority residents. Previous research indicates that blacks tend to receive care from lower quality nursing homes. Using the Institute of Medicine (IOM) definition of racial-ethnic disparities, this study decomposes nursing home disparities into within and across facility components. Using detailed person-level nursing home data, we find meaningful black-white disparities for one of the four risk-adjusted quality measures, with both within and across nursing home components of the disparity. The IOM approach, which recognizes mediation through payer status and education, has a small effect on measured disparities in this setting. Although we did not find disparities across the majority of quality measures and alternate disparity definitions, this approach can be applied to other health care services in an effort to disentangle the role of across and within facility variation and the role of potential mediators on racial/ethnic disparities.


Racial disparities Long-term care Decomposition methods


I10 J15