Racial differences in satisfaction with health care providers: An evaluation of three explanations.

African Americans are less likely than whites to be satisfied with their health care. In my dissertation I consider the multiple mechanisms by which race affects experiences in the health care system. I test three potential sources of the gap in satisfaction: (1) racial differences in health status, (2) structural level race differences in access to and source of care, and (3) individual level race differences in how health care providers treat patients. To assess these hypotheses I analyze focus group data collected for my dissertation and secondary quantitative data from the 1995 Detroit Area Study. The quantitative dependent variables that measure satisfaction are an evaluation of the health care provider on treatment with dignity and respect, and spending enough time in the examination. First, I find that although self-reported health and psychological distress generally have a negative relationship to race and satisfaction, African Americans' worse average health status does not account for lower satisfaction with health care providers. Second, the quantitative data do not indicate that access to or source of care explain much of the racial gap in satisfaction with care. However, nearly every focus group explained that patients with Blue Cross/Blue Shield receive better care than those with a health maintenance organization or public insurance. The degree to which this accounts for African Americans lower average satisfaction with health care providers cannot be clearly determined from these data. Third, individual level factors explain more of the statistical variation than the other factors. Whites reduced social distance from their health care provider, that is their greater likelihood of having a same-race health care provider and of having a higher income like their health care provider, explains much of the racial variation in satisfaction. Focus group data support the importance of having a health care provider with whom they have a personal connection. Finally, there is a debate about usefulness of expectations in understanding satisfaction with health care. The qualitative data suggest that expectations are useful for analyzing differences between groups with disparate life experiences. Specifically, race, education, and income seem to influence expectations for care.Ph.D.Black studiesEthnic studiesHealth and Environmental SciencesHealth care managementSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132828/2/9990931.pd