Detrimental health effects of discrimination: Does health care setting matter?

Discrimination is a powerful predictor of poorer health outcomes at the individual and population levels. This study seeks to understand how the perception of discrimination may vary depending on the type of medical care setting used by California adults. The specific aims are: (1) To investigate the associations between the type of medical care setting adults utilize most often and perceived experiences of both general and medical care-related discrimination; (2) To determine whether relationships vary by race/ethnicity, gender, socioeconomic position, and acculturation level. Data are drawn from the 2005 California Health Interview Survey (CHIS 2005). CHIS is a population-based random digit dial telephone survey of California residents conducted every two years to monitor health related indicators and relative changes. Interviews for CHIS 2005 were conducted in five languages. Adult CHIS 2005 participants (N=43,020) were interviewed between July 2005 and April 2006. The sample is comprised of Latinos (18.7%), Asians/Native Hawaiians/Pacific-Islanders (9.3%), African-Americans (4.2%), American-Indian/Alaska Natives (<1%), and Non-Latino Whites (64%). Preliminary results suggest that medical care setting is not an important predictor for general discrimination. However, those seeking medical care in community-based settings were 1.5 times more likely than those accessing services in HMO settings to report medical care-related discrimination (OR=1.55; CI: 1.17, 2.04). Further, differential effects were detected by race/ethnicity, gender, and income level. Acculturation effects will be explored in the final analysis. This study will enhance understanding of the complexity of discrimination, and will support public policy efforts toward equity and social justice within California's healthcare delivery system.