Racial and Socioeconomic Disparities in High- vs. Low-Value Health Service Use Among Emergency Medical Services-Transported Patients in New Jersey​

Avoidable care accounts for nearly 30 percent of U.S. healthcare spending, yet its distribution across racial and socioeconomic groups remains poorly understood. This study examines disparities in the provision of high-value versus low-value health services to patients transported by Emergency Medical Services (EMS) in New Jersey. By connecting NJ EMS Incident Data with NJ Hospital Discharge/Uniform Billing Data (2017-2024), we reconstruct each patient's EMS-hospital-discharge episode and classify inpatient services as high- or low-value using ICD-10-CM/PCS and CPT codes mapped to Choosing Wisely algorithms and AHRQ Quality Indicators. Fixed-effects logistic regression, paired with an instrumental variables correction and Geographically Weighted Regression, estimates how race, insurance, income, and EMS-derived factors predict service receipt and maps disparity hotspots across hospital service areas. We then simulate cost savings and health gains under targeted equity interventions, providing the first NJ-wide linked-data evidence to inform iPHD policy briefs, EMS protocol standardization, and provider incentive redesign.