Disparities in self-reported health and health care utilization: Does primary care experience matter?

Background and Purpose

A significant body of research in the last decade provides evidence to the persistent health disparities between African-Americans and White-Americans. Patient-provider relationships and quality of care perceptions have been found to be significant factors contributing to health disparities in the US. This research study contributes to bridge the wide gap in our understanding of how contemporary problems of prejudice and systematic bias impact the health of African-Americans. Besides showing the interconnections between racial status and health this study also establishes the relationship between individual perceptions, discrimination and health.

Methods

Data for this study comes from the MEPS- Household Component (HC), 2006. This dataset provides a nationally representative sample of US civilian non-institutionalized population. The MEPS sampling design oversamples Hispanics, Blacks and Asians, and hence it is a great opportunity to study disparities using this dataset. Descriptive statistics were used to show the socio-demographic attributes of the sample. Bivariate analyses were used to show the differences between Blacks and Whites in health outcomes, health care utilization and on the attributes of primary care. Multiple regression models were used to predict the impact of primary care experience on self reported health. In order to predict the impact of primary care experience on health care utilization, two-part models were used. The two part model is essentially a combination of a logistic regression model and a count regression model

Results

The results of the study show that health disparities exist between African-Americans and White-Americans on various domains of primary care. African-Americans express less satisfaction with the care they receive, and also report more waiting time, and problems of accessibility as compared to White-Americans. There are disparities in the use of services both preventive and non-preventive services and use of emergency room services. Primary care experience was found to be a significant predictor of health care utilization and self-reported health. The key finding from this study is that non-socio economic determinants like primary care experience can have significant impact on the health of minority populations.

Conclusions and Implications

This study fills a major gap in Social Work literature on understanding the relationship between primary care experience and health status of African-Americans. The study confirms recent findings in health literature that socio-economic determinants can only account for half of observed disparities between African-Americans and White-Americans. This study emphasizes the need for cultural competency in the health care systems. It also highlights the importance of the clinical interface between patients and providers. The study establishes the fact that Social Workers can play an effective role in health care institutions in delivering culturally competent services. Finally, Social Workers can use this research study to advocate for progressive social policies and interventions that address institutional discrimination.