Provider communication partially accounts for immigrant disparities in healthcare quality: Healthcare policy implications

Background: Perceptions of healthcare quality are lower among foreign- than US-born individuals. The objective of the present study was to identify possible explanations for this disparity.  Method: Data were from 6202 respondents to cycles 1 and 2 of the Health Information National Trends Survey 4 (HINTS 4) conducted 2011-2013, including 5425 US-born and 777 foreign-born respondents.  I used multivariable regression to model perceive quality of healthcare as a function of patient-centeredness of healthcare provider communication and health care access (having health insurance coverage, having a regular provider, and frequency of healthcare), controlling for English proficiency, race/ethnicity, education, age, marital status, gender, self-reported health, and survey cycle.  Results: Perceived quality of healthcare was lower among foreign-born than US-born respondents (b=-0.37, p<.001), accounted for, in part (46.2% reduction in effect), by foreign-born respondents experiencing relatively less patient-centered healthcare provider communication than US-born respondents. More patient-centered provider communication was associated with receiving higher quality healthcare in all respondents; having a regular provider was associated with perceived quality of care in foreign-born but not US-born respondents, and the reverse was true for frequency of care (ps<.05).  Discussion: Findings have healthcare policy implications. Culturally competent care and healthcare reform initiatives such as patient-centered medical homes and healthcare coverage expansion may improve patient-centeredness of care, access, and ultimately quality of care for some foreign-born individuals. It will, however, be necessary to monitor progress in immigrant healthcare quality as foreign-born individuals may also be disproportionately shut out of these very healthcare reforms.