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Care for some of the sickest Americans is decided in part by algorithm. New research shows that software guiding care for tens of millions of people systematically privileges white patients over black patients. Analysis of records from a major US hospital revealed that the algorithm used effectively let whites cut in line for special programs for patients with complex, chronic conditions such as diabetes or kidney problems.

The hospital, which the researchers didn’t identify but described as a “large academic hospital,” was one of many US health providers that employ algorithms to identify primary care patients with the most complex health needs. Such software is often tapped to recommend people for programs that offer extra support—including dedicated appointments and nursing teams—to people with a tangle of chronic conditions.

Researchers who dug through nearly 50,000 records discovered that the algorithm effectively low-balled the health needs of the hospital’s black patients. Using its output to help select patients for extra care favored white patients over black patients with the same health burden.

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