JAMA Network Open

Ellesse-Roselee L. Akr., Deanna Chyn, Heather A. Carlos, Amber E. Barnato, Jonathan Skinner

Considerable racial segregation exists in U.S. hospitals which cannot be explained by where patients live. Using 2019 Medicare claims data linked to geographic data, we define a hospital’s market based on ZIP-code based driving time, and estimate the racial composition of all hospitalizations in that market. We then compare the racial composition of the hospital with the racial composition of its market. In our sample of 4.9 million hospital admissions, we find a considerable degree of sorting, with Black Medicare enrollees more likely admitted to some hospitals in their market, and less likely to be admitted to other hospitals nearby.  At a regional level, we observed the greatest degree of patient sorting in the New York, Chicago, and Detroit HRRs.

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JAMA Network

Zack Cooper, Olivia Stiegman, Chima D. Ndumele, Becky Staiger, Jonathan Skinner

Little is known about small-area variations in health care spending and utilization across the 3 major funders of health care in the US: Medicare, Medicaid, and private insurers.

To measure regional health spending and utilization across Medicare, Medicaid, and the privately insured; to observe whether there are regions that are simultaneously low spending for all 3 payers; and to determine what factors are correlated with regional spending and utilization by payer.

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JAMA Network

Weifeng Weng, PhD; Jessica Van Parys, PhD; Rebecca S. Lipner, PhD; Jonathan S. Skinner, PhD; Brenda E. Sirovich, MD, MS

Use of healthcare services and physician practice patterns have been shown to vary widely across the United States. Although practice patterns—in particular, physicians’ ability to provide high-quality, high-value care—develop during training, the association of a physician’s regional practice environment with that ability is less well understood.

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