Understanding health service disparities in the United States requires analysis of features of health services and the American value of market justice. Building on Ostrom’s Institutional Analysis and Development framework, this paper identifies the factors affecting health service disparities. It empirically tests the significance of these factors by constructing and analyzing a large cross-sectional data set of 3147 American counties. The findings suggest that health service disparities can be resolved by actions taken by organizations and institutional arrangements to improve the biases and inefficiencies of health policy.