142nd APHA Annual Meeting and Exposition

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 12:30 PM - 12:50 PM

Galen H Smith III, PhD , Department of Political Science and Public Administration, University of North Carolina at Charlotte, Charlotte, NC
Teresa Scheid, Ph.D. , Department of Sociology, UNC-Charlotte, Charlotte, NC
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.


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.

Learning Areas:

Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Define patient-provider race and gender concordance and the concordance hypothesis Discuss the role that concordance plays in patient satisfaction and trust in one’s provider

Keyword(s): Health Disparities/Inequities, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: In the course of my doctoral dissertation studies, I conducted research in the areas of race and gender concordance and the role that these factors play in health disparities. Additionally, I have authored or co-authored several manuscripts on these topics that have been published in journals or compiled volumes. I am currently managing a research project that studies the impact of a number of variables, including race and gender concordance, in a comparable population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.