Disaggregating Racial and Ethnic Differences in Patient Perceptions of Access to Care: Using MEPS and CAHPS Data to Look Through the Eyes of the Beholder

Negative perceptions held by patients, healthcare workers and clinicians may impact whether treatment is sought, medical need is identified and healthcare is delivered. This study's objective was to investigate potential root causes of racial/ethnic disparities in patient perceptions of healthcare access in order to identify negative perceptions that may be addressed through appropriate interventions. Employing a cross-sectional study design, multivariate analyses were conducted using a two-part model with logistic regression to estimate unconditional outcomes (utilization) and conditional outcomes (patient perceptions, conditional on utilization having occurred). Likelihood of utilization estimated whether the patient had appointments or visits during the reporting period. Likelihood of patient perceptions measured receiving appointments as soon as desired, perceived/evaluated need for care, problems receiving care and patient-provider communication. Relative risks by race/ethnicity were also estimated for each outcome. The study utilized Medical Expenditure Panel Survey Household Component data (2005-2006) for adults aged 24-64 years. Race classifications included white, black, Asian/Pacific Islander (Asian/PI), American Indian/Alaskan Native (AI/AN) and multi-race. Ethnic classifications, which were not mutually exclusive of race, included non-Hispanic and Hispanic. Even after controlling for relevant covariates, including income, type/continuity of insurance and usual source of care provider, racial minorities, compared to whites, and Hispanics, compared to non Hispanics, were associated with significantly lower probabilities of utilization and higher probabilities of negative perceptions on most outcome measures: receiving appointments as soon as desired (RR black: 0.94; Asian/PI: 0.78); perceived/evaluated need for healthcare (RR black: 0.85; Asian/PI: 0.91; AI/AN: 0.84; Hispanic: 0.88); problems getting healthcare (RR black: 1.20; Asian/PI: 2.15; Hispanic: 1.32). With few exceptions, however, patient-provider communication estimates revealed no significant differences between racial/ethnic groups. The findings from this study reprise potentially disturbing questions given that racial/ethnic minorities have disproportionately high rates of disease, compared to non-minorities. First, are perceived signs and symptoms, or the motivation to seek preventive care, different for racial/ethnic minorities than for non-minorities? Patient perceptions may delay necessary care until minor health problems develop into major health crises. Second, how effective is communication during the clinical encounter? In order to appropriately diagnose and recommend treatment, clinicians must rely on information received from patients, in addition to physical exams/tests. Notwithstanding the findings of this and previous studies, the actual effectiveness of patient-provider communication and the way patients perceive it are not necessarily the same. Does ineffective communication disproportionately affect racial/ethnic minorities? Future research, education and outreach efforts should explore these questions.