Perceived Discrimination and Patient Experiences with Care

Ample research documents the existence of significant racial and ethnic disparities in access to healthcare, as well as poorer outcomes and health status among racial/ethnic minorities. National studies reveal racial/ethnic disparities in patient assessments of care. Culturally competent medical care is one strategy for reducing racial/ethnic differences in patient experiences with care. This study focuses on one domain of cultural competency, experiences of discrimination. It examines the relationships between patients' perceptions of discrimination, and their experiences with Medicaid as shown by the Consumer Assessments of Healthcare Providers and Systems (CAHPS) reports and ratings of care.

Data consist of randomly surveyed Florida Medicaid beneficiaries from September 2007 to December 2007. The survey included the Health Plan CAHPS 4.0 instrument and a set of items assessing patient experiences with discrimination. There was a 40% response rate, 1877 completed surveys. The data is limited to respondents with a personal doctor, resulting in 1509 completed surveys.

The dependent variables are Health Plan CAHPS 4.0 reports (getting needed care, timeliness of care, doctor communication, and health plan customer service) and ratings of care (personal doctor, specialists, health care, and health plan). Independent variables include measures of patient experiences with racial/ethnic discrimination. Variables related to systematic differences in survey responses are used as case-mix adjustors: gender, age, education, and health status. Data are analyzed using analysis of variance (ANOVA) and ordinary least squares regression.

Study results show that a significant proportion (9%) of the sample perceive discrimination as a result of race/ethnicity. Respondents who experienced discrimination sometimes significantly report more difficulties getting needed care (B=-21.7; p<.0001), getting care quickly (B=-11.5; p=.005) and communicating well with their doctors (B=-13.8; p<.0001) than those who never experienced discrimination. Moreover, patients who perceived discrimination sometimes significantly gave lower ratings for care received (â=-13.2; p<.0001), their personal doctor (B=-7.5; p=.005), specialist (B=-7.8; p=.017) and health plan's customer service (B=-13.83; p<.0001) compared to respondents who never experienced discrimination. These results suggest that perceptions of race/ethnic discrimination are associated with lower CAHPS reports and ratings of care.

Findings imply that Medicaid health plans should use quality improvement efforts to address perceptions of discrimination as a barrier to care for their enrolled patient population. Findings suggest that reducing perceptions of discrimination can result in improved CAHPS reports and ratings of care. The study also suggests the importance of assessing cultural competency from the patients' perspective, and including these measures in patient health care surveys.