Black Medicare patients face disproportionate admission to lower-quality hospitals despite living closer to higher-rated facilities, according to Johns Hopkins research published in PLOS One. Residential segregation alone cannot explain this troubling pattern, researchers found after analyzing 2019 Medicare claims data from more than 2,000 hospitals.
Assistant professor Ellesse-Roselee Akré developed the Local Hospital Segregation index to measure racial sorting in hospital admissions. Her findings revealed that structural factors within the health care system itself drive these disparities. Referral networks, intake processes, implicit bias, and historical institutional practices all influence where patients ultimately receive care.
The statistics paint a stark picture of inequality. A 10-percentage-point increase in the segregation index corresponded with a 79 percent higher likelihood that Black Medicare patients would be admitted to a one- or two-star hospital under the Centers for Medicare and Medicaid Services quality rating system. These lower-rated facilities consistently scored worse on safety, timeliness, patient experience, efficiency, and readmission measures.
“What we are seeing is segregation within the health care system itself—a sorting of patients of different races, in seen and unseen ways, even within the same neighborhood,” Akré said. These patterns persist even among Medicare beneficiaries with similar coverage and provider access.
Black Medicare patients face higher risks of death, complications, readmissions, and preventable safety events as a result of this sorting, consequences that likely widen existing health disparities. “Even when hospitals of differing quality sit just miles apart, clear patterns of racial sorting emerge,” Akré noted.
“Hospitals cannot control where people live, but they can control how they receive them,” she said.
See: “New Study Identifies Racial Inequality in U.S. Hospital Admissions” (February 12, 2026)
