Disparities In Physician Care: Experiences And Perceptions Of A Multi-Ethnic America

Abstract

This 2007 Harvard School of Public Health/Robert Wood Johnson Foundation survey of 4,334 randomly selected U.S. adults compared perceptions of the quality of physician care among fourteen racial and ethnic groups with those of whites. On each measure examined, at least five and as many as eleven subgroups perceived their care to be significantly worse than care for whites. In many instances, subgroups were at least fifteen percentage points more negative than whites. This was true for Central/South Americans, Chinese Americans, and Korean Americans on five of seven measures. Many of the differences remained after socioeconomic characteristics and language skills were controlled for. [Health Affairs 27, no. 2 (2008): 507-517; 10.1377/hlthaff.27.2.507] I t h a s n ow b e e n f o u r y e a r s s i n c e the Institute of Medicine's (IOM's) report Unequal Treatment documented broad racial and ethnic disparities in U.S. health care, using a variety of outcome and process measures. 1 One of those measures, perceptions of health care quality, has become an important gauge of disparities, not only because such differences highlight service gaps, but also because perceptions of care have been linked to overall health outcomes. 2 Research has found that Hispanic, Asian, and African Americans, compared to whites, report lower quality in their overall interaction with their physicians, less time spent with their physicians, poorer patient-physician communication, diminished trust in their physicians, and less respect from their physicians. 3 P h y s i c i a n C a r e n The Harvard/RWJF survey. This paper reports the results from a 2007 Harvard School of Public Health/Robert Wood Johnson Foundation (RWJF) national survey of fourteen minority ethnic subgroups' perceptions of the quality of their physician care. Our study fills a gap in the literature by providing current evidence for differences in perceived quality of physician care for each of these groups compared to whites. This multi-ethnic focus is important because, when discussing perceptions of health care quality, prior research has tended to look at the major ethnic groups (African Americans, Hispanic Americans, and Asian Americans) as homogenous groupings, even though group members are from different countries, cultures, and language backgrounds. Also, most prior studies have not examined the experiences of American Indians/Alaska Natives. There is reason to believe that members of these subgroups may have different health care experiences than other members of their ethnic groups. For example, Hispanic subgroups have been found to differ across multiple health outcomes, such as low birthweight, rates of premature birth, and mortality; African Americans of different backgrounds have been shown to have varying health outcomes; and Vietnamese Americans describe more health problems than other Asian Americans do, while Japanese Americans report fewer health problems than their fellow Asian Americans. 4 Given the heterogeneity within the larger ethnic gro...

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