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APHA Scientific Session and Event Listing

Ninez Ponce, MPP, PhD, Department of Health Services, UCLA, 31-254B CHS, Los Angeles, CA 90095-1772, 310-206-4021, nponce@ucla.edu and Gilbert C. Gee, PhD, Health Behavior and Health Education, University of Michigan, 1420 Washington Heights, Rm, M5224, Ann Arbor, MI 48102.

Racial discrimination in medical care has been identified as a source of disparities in health status. But patient dissatisfaction with care may also influence the perception of discrimination. We explore the extent of racial differences in reporting discrimination, and examine the independent effects of discrimination and dissatisfaction on measures of self-reported health status and health-related quality of life (HRQL) measures. Approximately 39,000 adults who reported a medical encounter in the past two years from the population-based 2003 California Health Interview Survey (2003 CHIS). Perceived discrimination was specified as a dichotomous outcome (1= reporting that one would get better medical care if they belonged to a different racial or ethnic group). Patient dissatisfaction of medical care was a continuous variable from 0=least dissatisfied and 10=most dissatisfied. Covariates included race/ethnicity, age, poverty level, education, gender, rural/urban residence, family composition and health insurance. We tested the effects of perceived discrimination and dissatisfaction on several health measures: general health status, count of chronic conditions, physically unhealthy days, mentally unhealthy days, and activity limitation days. We fit weighted OLS, negative binomial, logit, or an ordered logit model appropriate to the construct of the dependent variable. Racial and ethnic minority groups significantly reported higher odds of perceived discrimination than non-Latino whites (p<0.001 for each group): Latinos (OR 2.23), Asians (OR 1.82), African Americans (OR 4.03), American Indians/Alaska Natives (OR 2.87), Pacific Islanders and other single/multiple races (OR 2.25). A one unit increase in the dissatisfaction scale at the mean (1.98) was associated with nearly a 30% increased odds of reporting perceived discrimination. Including the dissatisfaction measure as a covariate increased the odds of reporting discrimination for each of the groups. In the health status and HRQL models, discrimination was consistently and robustly (p<0.001) associated with poorer health. Dissatisfaction was significant at p<0.001 for each outcome except chronic conditions. For each outcome, inclusion of dissatisfaction attenuated the effect of discrimination, but discrimination's effect remained significant across all health status measures. Racial and ethnic minorities report more discrimination in medical care and this perceived discrimination is strongly associated with poorer health status and worse HRQL. Although patient dissatisfaction of health care in part explains variations in health, discrimination still explains a larger part of health disparities. Standards set for providers to treat patients equally and fairly are deserving of the same credence given to patient satisfaction ratings as benchmarks for improving the quality of care.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe one measure of perceived racial/ethnic discrimination in a health care setting and one measure of patient dissatisfaction.
• Recognize that perceived discrimination varies by racial/ethnic group.
• List at least five indicators of self-rated health status and well-being.
• Discuss how discrimination and patient dissatisfaction are linked to self-rated health status and well-being.

Keywords: Equal Access, Patient Satisfaction

Presenting author's disclosure statement:

Any relevant financial relationships? No