Race, healthcare problems, consumer complaints and consumer satisfaction with the problem resolution process in the U.S. healthcare system

Background: Studies show that racial minorities, specifically African Americans, have worse health outcomes than whites across a large array of indicators of mortality and morbidity. Racial differences in perceived healthcare quality and treatment often elicit responses from minority consumers. However, little is known about minority consumers' 1) reasons/expectations for their complaints or 2) their experiences with the problem resolution process. Additionally, there has been limited study on the impact of psychosocial factors like social support, self-efficacy, health system vulnerability and patient trust on these consumerist outcomes. These psychosocial factors may be especially salient for minority health care consumers. These gaps represent significant limitations in our current models of medical consumerism in the U.S.

Objective: The purpose of this study was to determine whether minority patients had different evaluations of how well the healthcare system met their expectations for resolving a range of health care problems.

Methods: Data are from the Yale/ NY Academy of Medicine Survey of Consumer Experiences in Health Care, a nationally representative telephone survey conducted in 2002 (n=5000). Data were analyzed using multivariate logistic regression and ordered logistic regression with proportional odds models.

Results: Race had a significant impact on consumer goals for voicing dissatisfaction about health care experiences. Blacks were more likely to identify the goals of seeking payback for problematic experiences or seeking to “be heard” by the health system. Blacks were more likely to indicate satisfaction with problem resolution than whites. This finding, although consistent with other research on resolution, may be a reflection of minorities' lower initial expectations for the health system. Consumers with high patient trust were more likely to indicate being heard as a goal for consumer voicing and they were more likely to express satisfaction with their problem resolution process than those with low patient trust. Consumers who selected “seeking an explanation” or “seeking payback” as goals for consumer voicing were significantly less likely to indicate being satisfied with their problem resolution compared to people who did not select these goals.

Conclusion: Policy implications of this work suggest that the inclusion of consumer goal statements on complaints records and follow-up with consumers to see if expectations were met would be a positive innovation for health plan ombudsman offices. Exploring the nature of racial differences in problem resolution is especially relevant since these differences may affect future clinical decision making, health beliefs and health care seeking.