Racial disparities in health care utilization, the affordable care act and racial concordance preference

Ma, Alyson; Sanchez, Alison; Ma, Mindy

doi:10.1007/s10754-021-09311-8

Cited by 20 publications

(16 citation statements)

References 78 publications

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“… 31 Despite the reduction in the financial barriers and other factors that affect access to care in the advent of Affordable Care Act, disparities in health care between racial/ethnic groups continue to exist. 32 One surrogate of health care that we evaluated was the mean length of KPSC membership in our ADPKD cohort with kidney failure. The shorter length of membership among Hispanic and Asian ADPKD patients ( Table 1 ) may reflect shorter duration of CKD care provided to these patients, potentially contributing to earlier onset kidney failure.…”

Section: Discussionmentioning

confidence: 99%

Health Disparities in Kidney Failure Among Patients With Autosomal Dominant Polycystic Kidney Disease: A Cross-Sectional Study

Harrison¹,

Chen²,

Lee³

et al. 2023

Kidney Medicine

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Section: Discussionmentioning

confidence: 99%

Health Disparities in Kidney Failure Among Patients With Autosomal Dominant Polycystic Kidney Disease: A Cross-Sectional Study

Harrison¹,

Chen²,

Lee³

et al. 2023

Kidney Medicine

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“…Physicians from racial and ethnic minority groups have been shown to care for the majority of non–English-speaking and racial and ethnic minority patients in the US . Additionally, even when controlling for financial barriers to health care access, the racial and ethnic concordance of patients and physicians is directly associated with health care use . Furthermore, having diverse peers can enhance the educational experiences of all trainees regardless of race and ethnicity and can better prepare medical students in caring for diverse populations …”

Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

Iwai,

Yu,

Daniels

et al. 2023

JAMA Surg

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ImportanceSurgical department chairs remain conspicuously nondiverse despite the recognized importance of diverse physician workforces. However, the extent of diversity among non-chair leadership remains underexplored.ObjectiveTo evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs) in the US.Design, Setting, and ParticipantsFor this cross-sectional study, publicly accessible medical school and affiliated hospital websites in the US and Puerto Rico were searched from January 15 to July 15, 2022, to collect demographic and leadership data about surgical faculty. Two independent reviewers abstracted demographic data, with up to 2 additional reviewers assisting with coding resolution as necessary. In all, 2165 faculty were included in the analyses.Main Outcomes and MeasuresProportions of racial, ethnic, and gender diversity among chairs, VCs, and DCs in general surgery and 5 surgical specialties (neurosurgery, obstetrics and gynecology, ophthalmology, orthopedics, and otolaryngology).ResultsA total of 2165 faculty (1815 males [83.8%] and 350 females [16.2%]; 109 [5.0%] African American or Black individuals; 347 [16.0%] Asian individuals; 83 [3.8%] Hispanic, Latino, or individuals of Spanish origin; and 1624 [75.0%] White individuals as well as 2 individuals [0.1%] of other race or ethnicity) at 154 surgical departments affiliated with 146 medical schools in the US and Puerto Rico were included in the analysis. There were more males than females in leadership positions at all levels—chairs (85.9% vs 14.1%), VCs (68.4% vs 31.6%), and DCs (87.1% vs 12.9%)—and only 192 leaders (8.9%) were from racial or ethnic groups that are underrepresented in medicine (URiM). Females occupied more VC than chair or DC positions both overall (31.6% vs 14.1% and 12.9%, respectively) and within racial and ethnic groups (African American or Black females, 4.0% VC vs 1.5% chair and 0.6% DC positions; P &lt; .001). URiM individuals were most commonly VCs of diversity, equity, and inclusion (DEI, 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split equally between males and females, while 64.5% of VCs for DEI were female. All other VCs were predominantly male. Among DC roles, URiM representation was greatest in transplant surgery (13.8%) and lowest in oral and maxillofacial surgery (5.0%). Except for breast and endocrine surgery (63.6% female), females comprised less than 20% of DC roles. Nearly half of DCs (6 of 13 [46.2%]) and VCs (4 of 9 [44.4%]) had no female URiM leaders, and notably, no American Indian, Alaska Native, or Native Hawaiian or Other Pacific Islander individuals were identified in any surgical leadership positions.Conclusions and RelevanceWhile it is unclear whether promotion from VC to chair or from DC to chair is more likely, these findings of similar gender distribution between chairs and DCs suggest the latter and may partially explain persistent nondiversity among surgical chairs. Female and URiM surgical leaders are disproportionately clustered in roles (eg, VCs of DEI or faculty development) that may not translate into future promotion to department chairs.

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“…In particular, the results suggested that while racial concordance remains a significant factor, it accounted for a small share of the decision to seek medical treatment when financial barriers to health services were reduced. 16 The aims of this study are three-fold. First, we use nationally representative data (the 2019 Medical Expenditure Panel Survey) to determine which patients report a racially concordant primary care clinician as well as the share who lack an individual primary care clinician because they lack a usual source of care or because the usual source is a facility (e.g., a clinic or center) rather than an individual.…”

Section: Introductionmentioning

confidence: 99%

The Association of Racial and Ethnic Concordance in Primary Care with Patient Satisfaction and Experience of Care

Vichare

2022

J GEN INTERN MED

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BACKGROUND:The lack of racial and ethnic concordance between patients and their physicians may contribute to American health disparities. OBJECTIVE: To examine the level of racial and ethnic concordance for patients and primary care clinicians and its association with measures of patient experience. DESIGN: Multivariate cross-sectional analysis of nationally representative data. PARTICIPANTS: Adults 18 to 64 in the 2019 Medical Expenditure Panel Survey who had at least one medical visit in the past year. MAIN MEASURES: Key independent variables include having a racially/ethnically concordant primary care clinician, lacking a usual source of care, and having a usual source that is a place rather than a person. Outcomes include overall satisfaction with health care, number of medical visits, having enough time in care, ease of understanding the clinician, and receiving respect. KEY RESULTS: The comparison between the actual level of concordance with an expected distribution if all patients had the same probability of having a clinician of a given race or type indicates that Black, Latino, and Asian patients are three or more times as likely to have a concordant clinician than expected, suggesting a strong preference for clinicians of the same race or ethnicity. Racial or ethnic concordance has a modest positive association with overall health care satisfaction and respect but is not significantly associated with the number of medical visits or other outcomes. Poor health status, being uninsured, and lacking a usual source of care are more strongly associated with patient experience. DISCUSSION: Efforts to increase the diversity of the primary care workforce could increase racial/ethnic concordance but may have only modest effects on patients' experience of care. Policies like lowering the number of uninsured or increasing those with a usual source of care may be more salient in improving experience of care.

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Racial disparities in health care utilization, the affordable care act and racial concordance preference

Cited by 20 publications

References 78 publications

Health Disparities in Kidney Failure Among Patients With Autosomal Dominant Polycystic Kidney Disease: A Cross-Sectional Study

Health Disparities in Kidney Failure Among Patients With Autosomal Dominant Polycystic Kidney Disease: A Cross-Sectional Study

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

The Association of Racial and Ethnic Concordance in Primary Care with Patient Satisfaction and Experience of Care

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