Racial Differences in Health Care: Evidence from the Veterans Health Administration

Emilia Simeonova, Columbia University

Research in the last twenty years has shown persistent racial differences in health care access, utilization, and outcomes. A few studies have attempted to link hospital racial segregation to individual outcomes. However, the literature has paid little attention to determining causality. This paper uses a national sample of veterans utilizing the Veterans Health Administration and offers several contributions. First, a reform of the Veterans Administration provides an exogenous change in the racial composition of outpatient clinics. Using instrumental variables techniques I overcome the endogeneity problem encountered in previous empirical research. Second, I construct measures of continuity of care and patient compliance and investigate their effect on health. Finally, merging several sources of data provides a much richer set of controls and outcomes for the same population than previously available. Results show the effect of race and racial segregation change significantly when the full set of controls is included.