Can physician-patient concordance increase trust and satisfaction for women enrolled in Medicaid primary care?

Background: In this paper we examine physician-patient concordance which can remove barriers to health care by improving physician-patient communication and increasing patient trust and satisfaction, thus reducing health disparities. We examine differences between White and Black women enrolled in Medicaid and receiving primary care, hence controlling for social class as well as access to health care. We include both race and gender concordance, and also control for the availability of minority (both Black and female) providers.

Methods: The data were collected from a stratified random sample of adults enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006-2007. We included only those female respondents who had seen a doctor in the past six months (n = 1,437); 40.3% were Black and 59.7% were White. The dependent variables were satisfaction and trust. Included in the logistic regression models is need for health care, race and gender concordance, participatory decision making, months enrolled with primary care provider, access to specialty care, and the percentage of minority health providers available in the Medicaid network. We also controlled for urbanicity, age, and education.

Findings:

Bivariate Analysis: Compared to White women, Black women had higher reported health status, were less likely to be in race concordant relationships (probably due to the low percentage of Black providers) had longer relationships with their health care providers, but less participation in decision making and less trust. There were no significant differences in gender concordance or satisfaction.

Multivariate Analysis: Education, race, and satisfaction with one’s health care were significant predictors of trust in one’s provider. Age, access to specialty care, education, health status, trust in one’s provider, and the percentage of female providers by care network were all significant predictors of satisfaction. While race concordance was not statistically significant in predicting either trust or satisfaction, gender concordance was a significant predictor of satisfaction (p = 0.054).

Conclusion: This study not only included gender concordance, but also controlled for the availability of minority (Black or women) providers. There were more women providers available to respondents, which improved satisfaction – pointing to the importance of gender concordance. Given that Black women had less trust and lower participation in decision making than White women, it is likely that with more Black providers, race concordance would also lead to improved health care outcomes for Black women.