An Application of the Andersen Model of Health Utilization to the Understanding of the Role of Race-Concordant Doctor–Patient Relationships in Reducing Health Disparities

• Published in: Social Determinants, Health Disparities and Linkages to Health and Health Care Vol. 31; pp. 187 - 214
• Main Authors: Smith, Galen H., Scheid, Teresa L.
• Format: Book Chapter
• Language: English
• Published: Emerald Group Publishing Limited 01-01-2013
• Subjects: Medical demographics; Medical sociology; Science in sociology; Sociology; Sociology of health & illness; trust; utilization; satisfaction; Medicaid; Race concordance
• ISBN: 1781905878; 9781781905876
• ISSN: 0275-4959
• DOI: 10.1108/S0275-4959(2013)0000031011

Abstract
Purpose
The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by extension, encourages patients to seek and utilize health care, which may reduce health disparities. However, relatively few studies have examined the impact of race concordance on the utilization of health services. This chapter is grounded on Andersen’s Emerging Model of Health Services Utilization (Phase 4) and extends that model to include race concordance.
Methodology/approach
The data were collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006–2007. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and indices were constructed to generate key control variables. Poisson regression was used to examine the impact of race concordance on the utilization of primary care and emergency room care, under the assumption that race concordance would increase the use of primary care and decrease the use of emergency care for minority patients.
Findings
While blacks (compared to whites) used less primary care and had more emergency care visits, race concordance was not a statistically significant predictor of either primary care or emergency room use. However, patients’ satisfaction with their primary care providers was associated with significantly fewer primary care and emergency care visits while trust in one’s provider was associated with more primary care visits.
Research implications
The study findings suggest that the central premises of the race concordance hypothesis require further study to confirm the assumption that better patient – primary care provider relationships result in less utilization of more costly and resource-intensive forms of health care.
Value of chapter
The study makes a valuable contribution by expanding the relatively small body of literature dedicated to exploring the impact of race concordance on health services utilization. Additionally, by virtue of researching the experience of Medicaid enrollees, the study controls for health insurance status.