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Research
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"Doctors, Patients, and the Racial Mortality Gap: What Are the Causes?" (Job Market Paper)
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Abstract: Disparities in health outcomes between white Americans and minorities are well documented.
Discrimination and unequal access to care are frequently cited explanations for the racial differences in
mortality. It has been alleged that doctors treat minority patients differently or that they are trapped in
facilities of inferior quality. I use a new dataset from the Department of Veterans Affairs and employ a
novel estimation strategy to investigate the sources of the racial gap in mortality for the most expensive
chronic condition in the elderly. In a sample of patients with equalized access to health care, I show
that quality of the clinics or doctors is not the underlying reason for racial differences in black and
white mortality. It is demonstrated that doctor competence significantly influences patient outcomes;
that minorities and whites have access to similar physician quality, and that doctors treat patient
similarly regardless of race. Differences in patient self-management trigger a racial mortality gap even
when access and treatment are equalized. Considerable reductions in medical costs could be achieved
by instructing patients about the importance of strictly following the therapy regimen. A special
emphasis on educating minorities will have the added benefit of reducing the black-white mortality gap
by at least two-thirds.
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"Choice of Currency in Bond Issuance and the International Role of Currencies", with Cristina Vespro and Nikolaus Siegfried,
European Central Bank Working Paper 841
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