Comparing Methods of Racial and Ethnic Health Care Disparities Measurement

• Activity Number: 597
• Type: Topic Contributed
• Date/Time: Wednesday, August 12, 2015 : 2:00 PM to 3:50 PM
• Sponsor: Social Statistics Section
• Author(s): Benjamin Cook*
• Companies: Harvard Medical School
• Keywords: disparities ; propensity score ; race ; rank order ; ethnicity ; mental health

Abstract

We compare conceptual and empirical strengths of alternative methods for estimating racial disparities using non-linear models of health care access. We discuss methods that are concordant with the IOM definition of racial/ethnic healthcare disparities which defines disparities as all differences except those due to clinical appropriateness and need and patient preferences. Three methods are presented (propensity score, rank and replace, and a combined method) that adjust for clinical appropriateness and need while allowing differences in non-need variables to enter into the disparities calculation. We empirically compare the methods' predicted disparity estimates, variance, and the sensitivity of the estimates to limitations of available data. The rank and replace and combined methods (but not the propensity score method) are concordant with the IOM definition. Predicted disparities and variances were similar, but the rank and replace method was sensitive to limitations on non-need variables. We conclude that either IOM-concordant method can be used. In datasets with limited SES information, the combined method is the better choice.