Racial/Ethnic Variation in Healthcare Satisfaction

Background and Purpose: Healthcare satisfaction is important when decisions are made about changes and improvement in service which is directly relevant to quality of care. Previous studies found patient characteristics (e.g., age, gender, or region) and healthcare quality attributes (e.g., physician care or staff care), as predictors of healthcare satisfaction, and that racial/ethnic minorities are less satisfied with their healthcare services regardless of insurance type or health problem, mainly due to a lack of multicultural competence and cultural sensitivity of healthcare professionals. However, little is known about the role of acculturation and racial/ethnic variation in healthcare satisfaction. This study examined racial/ethnic variation in healthcare satisfaction among four different racial/ethnic groups.

Methods: Data were obtained from the 2011 California Health Interview Survey (CHIS). The CHIS is the nation's largest population-based health survey by using a random-digit telephone survey method (UCLA Center for Health Policy Center, 2013). The sample for the current study consisted of 42,935 adults, including White (n=25,814), Hispanic (n=9,506), Asian (n=4,235), and Black (n=2,005). To measure healthcare satisfaction of respondents, the following two questions were used: (1) How often Doctor listens carefully and (2) How often Doctor carefully explains what to do. Both questions were originally measured on a four-point Likert scale, ranging from 1 (never) to 4 (always), but dichotomized measures were used in the model. The level of acculturation was measured by English proficiency (good vs. not good). Guided by Andersen’s behavioral health service utilization model, two logistic regression analyses were conducted to examine racial variation in healthcare satisfaction while controlling for predisposing, enabling, and need factors. To account for the CHIS’s complex sampling designs, all statistical analyses were conducted using the survey procedures of STATA version 11.

Results: White respondents (Mean= .93) reported the highest level of healthcare satisfaction in doctor’s listening, followed by Black (Mean= .92). However, Black (Mean= .94) has the highest level of healthcare satisfaction in doctor’s explanation, followed by White (Mean= .93). The logistic regression models also indicated that, after controlling for other covariates, white respondents reported a higher level of healthcare satisfaction with doctor’s listening when compared to their Hispanic and Asian counterparts (OR=-0.27, p<0.01; OR=-0.04, p<0.001, respectively). In regard to doctor’s explanation, same results were found; White was more like to have a high level of healthcare satisfaction than Hispanic and Asian (OR=-0.22, p<0.05; OR=-0.48, p<0.001, respectively). As an acculturative factor, English proficiency was found as a marginally significant predictor of healthcare satisfaction with doctor’s explanation (OR=0.24, p=0.51), indicating that those with better English proficiency were more likely to have a high level of healthcare satisfaction when compared to those with limited English proficiency.

Conclusion and Implications: Findings suggest that healthcare professionals have to be aware of the role of acculturation and racial/ethnic variation in healthcare to improve quality of care. Given that limited English proficiency is considered one of the most challenges to healthcare among racial/ethnic minorities, it is important to have more culturally competent healthcare professionals, who are bilingual and bicultural, to better provide quality of care.