Experiences of medical care-related discrimination: Important lessons learned from a study including California's safety-net clinics

We investigated the associations between the type of health care setting that California adults report as their regular source of care: “Doctor's Office” (doctor's office/Kaiser/other HMO); Likely “Safety-net Clinic Users” (clinic/health center/hospital clinic), limited to those who were at or below 200% federal poverty level and had public insurance (Medicaid or Healthy Families) or were uninsured; Likely “Non-safety Net Clinic Users” (clinic/health center/hospital clinic), limited to those whose income was greater than 200% FPL and had insurance that was not publicly funded; “Other” (emergency room/alternative medical care/family/friend/other, or no one place); and those who had “No Usual Source of Care,” and perceived racial/ethnic medical care-related discrimination. Data were analyzed from the 2005 California Health Interview Survey, a cross-sectional survey using a geographically stratified random digit dial sample of California households (n= 36,694 adults who visited a physician in the past year). “Non-safety Net Clinic Users” had increased odds for perceived racial/ethnic discrimination (OR 1.76, CI:1.32-2.35), whereas ”Safety-net Clinic Users” users appear to experience discrimination at rates that are similar to those seeking care at private and HMO doctor's offices. Additionally, African-Americans had the greatest odds for perceiving racial/ethnic discrimination (OR 3.42, CI: 2.40-4.87). Our findings suggest that much could be done to improve the experiences of adults seeking care in Non-safety Net Clinics. Safety-net clinics might serve as models for delivering care since they are already dedicated to serving vulnerable populations and are committed to implementing initiatives designed to reduce health disparities and enhance social justice.