Race- and insurance-based disparities exist in the utilization of high-volume hospitals for complex surgery. Retrospective analysis of the Nationwide Inpatient Sample from 1988 through 2005 was performed to examine hospital volume trends for eight procedures. Ordered logistic regression analyses were performed to determine temporal trends in the utilization of high-volume hospitals by minority and Medicaid-insured patients compared with white patients and those with private insurance or Medicare. Black patients are increasing their utilization of higher-volume hospitals, but not at a rate sufficient to overcome existing disparities relative to the utilization of such hospitals by white patients. Meanwhile, disparities in the utilization of higher-volume hospitals are increasing for Hispanics and patients who are primarily insured through Medicaid. Existing racial and insurance-based disparities in the utilization of high-volume surgical care will persist or become even more pronounced without active intervention from health care policymakers.