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The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by extension, encourages patients to seek and utilize health care, which may reduce health disparities. However, relatively few studies have examined the impact of race concordance on the utilization of health services. This chapter is grounded on Andersen’s Emerging Model of Health Services Utilization (Phase 4) and extends that model to include race concordance.

The data were collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006–2007. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and indices were constructed to generate key control variables. Poisson regression was used to examine the impact of race concordance on the utilization of primary care and emergency room care, under the assumption that race concordance would increase the use of primary care and decrease the use of emergency care for minority patients.

While blacks (compared to whites) used less primary care and had more emergency care visits, race concordance was not a statistically significant predictor of either primary care or emergency room use. However, patients’ satisfaction with their primary care providers was associated with significantly fewer primary care and emergency care visits while trust in one’s provider was associated with more primary care visits.

The study findings suggest that the central premises of the race concordance hypothesis require further study to confirm the assumption that better patient – primary care provider relationships result in less utilization of more costly and resource-intensive forms of health care.

The study makes a valuable contribution by expanding the relatively small body of literature dedicated to exploring the impact of race concordance on health services utilization. Additionally, by virtue of researching the experience of Medicaid enrollees, the study controls for health insurance status.

The purpose of this paper is to examine race, gender and language concordance in terms of importance to primary care.

The 2003 Medical Expenditure Panel Survey Household Component (MEPS) was used. Four distinguishing primary care attributes and selected measures were operationalized primarily from a sample subset that identified a usual source of care (USC): accessibility to USC; interface between primary care and specialist services; treatment decisions; and preventive services received from the USC. Bivariate and multivariate results are reported.

Adjusting for covariates, the following items remained statistically significant: race – choosing primary care physician as USC, USC having office hours, and going to USC for new health problems; gender – choosing primary care physician as USC and USC having office hours; and language – lack of difficulty contacting the USC after hours. However, these items appear to be isolated cases rather than indicators that concordance plays a key role in determining primary care quality. Language barriers/communication issues are the only areas where improvement appears warranted.

While the study has strong accessibility and interpersonal relationship measures, service coordination and comprehensiveness indicators are limited. The analyses' cross‐sectional nature also poses a problem in drawing causal relationships and conclusive findings. Finally, sample size limitations preclude stratified analyses across racial/ethnic groups, an important consideration as the relationships between concordance and quality may vary across groups.

This study indicates that more research is needed in this area to determine future resource allocation and policy direction.

The unique contribution of the study is to suggest that race and gender concordance may not accurately predict primary health care quality.

Existing descriptions of trust in health care largely assume a straightforward association between a patient’s relationship with a regular provider and his or her trust in health care. I extend status characteristics theory (SCT) and social identity theory (SIT) to suggest greater variability in this association by investigating the role of social differences between patients and their regular providers. Whereas the SIT extension predicts lower trust in dissimilar than similar dyads, the predictions from the SCT extension depend on status in dissimilar dyads. Further, research examining how social differences in patient–provider dyads shape trust largely emphasizes racial differences, but the theories implicate gender differences too.

I analyze a longitudinal dataset of patient–provider dyads offering a conservative test of the extensions.

Results generally support predictions from the SCT extension. Specifically, patients’ status based on differences in either race or gender: (1) is inversely related to their trust in health care and (2) influences the resiliency of their trust, whereby the degree health care met prior expectations matters less (more) for the trust of low (high) status patients than equal status patients.

When patients and providers differ on both race and gender, findings sometimes depart from predictions. This indicates differences in two social categories is a unique situation where the contributions of each category are distinct from that of the other.

This research extends SCT to explain greater variability in the connection between patient–provider dyads and trust in health care, while also showing how gender compares to race.

The increasing diversity among workforces – as well as the increasing diversity among patient populations served – offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration.

This conceptual paper develops a framework that combines three organizational behavior theories – emotional labor theory, similarity-attraction theory and climate theory – with evidence from the broader healthcare literature.

Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier.

The authors offer a conceptual model to unlock positive outcomes – including reduced absenteeism, better morale and improved patient satisfaction – regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.

This chapter provides both an introduction to the volume and a review of literature on health disparities and social determinants.

Literature Review.

The chapter argues for the importance of greater consideration of social determinants of health disparities. This includes a consideration of race/ethnicity and socioeconomic status factors, geographic and place factors, and disparities especially linked to particular diseases.

Reviews the topic of health disparities and social determinants and previews this book.

Implicit bias is the application of an unconscious attitude or belief; in the clinical setting, a provider’s perception of a patient, based upon perceived race or ethnicity, is hypothesized to affect clinical decisions, provider-patient interactions and patient health. The purpose of this paper is to provide a brief synopsis of and critique the relevant works over the past 15 years while highlighting the strengths of this body of literature.

A MEDLINE search, from 2000 to 2015, using the terms “implicit bias,” “unconscious bias” and “aversive racism” was performed. US-based studies investigating the effect of racial or ethnic implicit bias on the clinical encounter or patient outcomes were assessed. In total, 15 articles were eligible for review.

Despite well-reasoned hypotheses that racial/ethnic bias negatively affects patient care, this review found mixed results. Largely, studies showed that US-providers hold an anti-black implicit bias negatively affecting patient-provider communication and patient satisfaction. But studies have not shown that this bias consistently negatively affects diagnosis and treatment regimens of black patients in comparison to white patients. There is a significant dearth of implicit bias literature addressing the care of other patient groups of color.

This review of the recent literature challenges the black-white dichotomy of most implicit bias research in the USA and highlights the lack of patient-oriented outcome research in this field. Furthermore, it demonstrates that regardless of the effect of implicit bias on patient outcomes, focus on eliminating implicit bias is insufficient to improve the health of people of color.

A fairly consistent finding in research on trust in physicians is that racial and ethnic minorities cite lower levels than whites. This research typically samples only health care users, which limits our understanding of what underlies distrust. It remains unclear whether the distrust is generalized, which is distrust that is unrelated to using health care regularly or recently.

Using data from the Health Information National Trends Survey, multivariable logistic regressions assessed whether racial and ethnic differences in distrust (1) are equivalent among health care users and non-users; (2) regardless of respondents’ health and socio-economic status; and (3) manifest in other health information sources.

Racial and ethnic minorities are less likely than whites to trust physicians as health information sources. These racial and ethnic differences are equivalent among health care users and non-users, regardless of respondents’ health and socio-economic status. The racial and ethnic patterns do not manifest when predicting trust in other health information sources (Internet, family or friends, government health agencies, charitable organizations).

Data are derived from a cross-sectional survey, which makes it difficult to account comprehensively for self-selection into being a health care user. Despite the limitations, this research suggests that racial and ethnic minorities possess a generalized distrust in physicians, necessitating interventions that move beyond improving health care experiences.

Many researchers have surmised that a generalized distrust in physicians exists among racial and ethnic minorities. This chapter is the first to explicitly examine the existence of such distrust.

This study investigates racial and ethnic patterns in perceived non-adherence among American White, Black, Hispanic, and Asian health care users, using data from a national sample of recent health care users (N=5,124). We estimated multivariate logistic regression models of perceived non-adherence for all respondents and by respondents’ race/ethnicity. The results revealed that Blacks and Hispanics respectively had 39 percent and 36 percent lower odds of perceived non-adherence compared to Whites, but the odds of perceived non-adherence were 91 percent higher among Blacks who reported having experienced racial/ethnic bias in health care when compared to other Blacks. Good physician–patient communication was associated with a 63 percent lower odds of perceived non-adherence among Whites and Hispanics. The results suggest that compared to Whites, Blacks and Hispanics are less, not more, likely to report perceived non-adherence.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

Although Black individuals are disproportionately affected by hypertension as evidenced by higher prevalence and lower control rates, few studies have investigated this disparity from the lens of those most affected by this condition. This chapter explores how Black men make sense of their hypertension and how they negotiate this condition within their everyday lives, illuminating how racism and power dynamics embedded within their environments affect their experiences living with hypertension.

Critical Race Theory tenets were utilized alongside a narrative design to elicit stories of hypertension experiences of four Black men living in Ontario, Canada. Eight semistructured in-depth interviews were conducted, transcribed, and thematically analyzed to illuminate how participants create meaning in regard to their hypertension.

Participants’ experiences with discrimination, isolation, and migration raise awareness of how power relations embedded within social, political, and historical contexts can affect hypertension experiences.

The findings of this study are bounded by its narrative context, and the characteristics of the individuals who shared their experiences.

This study highlights the importance of how discussions concerning hypertensive minority men should be broadened to include the voices of such men, as well as the structures that discriminate against and oppress minority individuals.