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Market structure and gender disparity in health care: preferences, competition, and quality of care


  • This article has benefited from the comments of Peter Arcidiacono, Guy Arie, Pat Bayer, Jen Brown, Federico Bugni, Meghan Busse, David Dranove, Shane Greenstein, Paul Grieco, Ben Handel, Igal Hendel, Joe Hotz, Tom Hubbard, Kei Kawai, David Matsa, Michael Mazzeo, Aviv Nevo, Jason O'Connor, Frank Sloan, Andrew Sweeting, Mauricio Varela, Nic Ziebarth, and many seminar participants. We gratefully acknowledge research support from the Social Sciences Research Institute at Duke University, a Northwestern University Graduate Research Grant, and the Center for the Study of Industrial Organization. We especially thank Dr. William J. McDevitt and Dr. Edward Messing for providing invaluable background information about urology.


We consider the relationship between market structure and health outcomes in a setting where patients have stark preferences: urology patients disproportionately match with a urologist of the same gender. In the United States, however, fewer than 6% of urologists are women despite women constituting 30% of patients. We explain a portion of this disparity with a model of imperfect competition in which urology groups strategically differentiate themselves by employing female urologists. These strategic effects may influence women's health, as markets without a female urologist have a 7.3% higher death rate for female bladder cancer, all else equal.