ABSTRACT:
Healthcare systems in Europe have been profoundly reshaped by neoliberal reforms emphasizing cost containment, efficiency, and productivity.¹ While research documents racialized inequities in healthcare access and quality,²-⁴ less attention has been paid to how these inequities are produced through the infrastructural and political-economic conditions that shape clinical decision-making. This paper examines whether stress—conceptualized as a structural manifestation of economization—shapes physicians’ clinical judgments in racially differentiated ways. We draw on a factorial survey experiment conducted with 828 physicians in Germany. Using a 2×2 between-subjects design, clinical vignettes experimentally manipulated stress through time pressure and cognitive load⁵ and patient racialization through visual cues indicating a racialized versus white patient, while holding clinical information constant. Physicians assessed disease seriousness and the likelihood of angina pectoris in an emergency care scenario. Supplemental survey items captured perceptions of resource scarcity and cost-containment pressures in everyday clinical practice.⁶,⁷ Results indicate that stress significantly reduced physicians’ assessments of disease severity and diagnostic likelihood overall. Importantly, these stress effects were more pronounced for racialized patients, indicating that stress amplifies racialized disparities in clinical judgment. These findings resonate with qualitative evidence showing how racialized patients experience othering and silencing within German healthcare, contributing to inequities in care quality and trust in the system,⁸ and with research demonstrating how economic conditions shape institutional racism and everyday clinical work.⁹ Descriptive survey data further reveal widespread perceptions of staff shortages, excessive cost pressure, and unequal resource distribution within physicians’ workplaces. The findings suggest that racialized inequities in healthcare cannot be adequately explained by individual bias alone. Instead, they are embedded in the neoliberal restructuring of healthcare systems, where economization intensifies conditions under which racialized classifications shape clinical decisions.¹⁰ Addressing racism in healthcare therefore requires attention to political-economic determinants, institutional conditions, and educational interventions.