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In Their Own Words
The Hidden Payment Gap That Shapes Who Gets a Doctor’s Visit
Lower Pay for Black and Hispanic Patients Drives Unequal Access to Care
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This op-ed by Aaron Schwartz and Rachel M. Werner was published on January 11, 2026 in the Philadelphia Inquirer.
Sometimes, in our bewildering health system, a patient’s gratitude is a sign of how much the system has failed them. When someone tells a new doctor, “I feel so lucky to see you,” the appreciation can come from years of trying to get high-quality care. And much of that struggle may not be accidental — it is the direct result of how our health system pays doctors.
As a new year begins, it’s worth confronting a hard truth: Our healthcare system fails to treat everyone equally. A key reason is the financial incentives we have created. We pay doctors less to care for some people than others.
Our new research shows that practices receive 8.8% less for visits with Black patients and nearly 10% less for Hispanic patients than for their white peers. For children, the gaps are even wider. Physicians got 13.9% less for visits with Black children and 15% less for Hispanic children.
This disparate pay will only worsen after the largest funding cut in Medicaid’s history.
How does this affect patients? Consider childhood asthma. Having a regular pediatrician and the right inhalers can mean the difference between living symptom-free and taking many miserable trips to the emergency room. Yet, one in eight children with asthma lacks a usual place for care, the Centers for Disease Control and Prevention reports, and poor access is far more common for Black or Hispanic children than for their white counterparts.
Read the full op-ed.
Authors
Aaron Schwartz, MD, PhD
Assistant Professor, Medical Ethics and Health Policy, Perelman School of Medicine
Rachel M. Werner, MD, PhD
Executive Director, Penn LDI; Robert D. Eilers Memorial – William Maul Measey Professor in Health Care Management and Economics, Wharton School; Professor, Medicine, Perelman School of Medicine
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