Impact of patient-provider race concordance on empowered decision-making among North Carolina Medicaid enrollees

The race concordance hypothesis suggests that correspondence in race between patients and health providers improves a number of health-related outcomes, including communication, satisfaction, trust, and utilization of health services. Race concordance has also been linked to empowered decision-making by the recipients of health services. New data generated by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) 4.0 survey instrument enable the authors to examine the impact of race concordance on empowered decision-making in the white and black subpopulations of adult and child beneficiaries enrolled in North Carolina Medicaid's managed care network delivery system. The telephone survey was conducted in summer 2012. The dependent variable is a complex index derived from multiple survey items relevant to patient decision-making. The independent variable of interest is race concordance; several other variables (e.g., language concordance) serve as control variables. Propensity score matching controls for potential health care provider selection bias. Regression analysis seeks to reveal differences in empowered decision-making among concordant and discordant groups in the eight possible subpopulation combinations. The findings will be compared to similar studies of a 2006-2007 survey of N.C. Medicaid enrollees. The study findings will inform policymakers and other stakeholders committed to combating race-based disparities in health care.