Racial and Ethnic Differences in a Patient Survey

BACKGROUND: Few studies have investigated the influence of race and/or ethnicity on patients' ratings of quality of care. None have incorporated patients' values and beliefs regarding medical care in assessing these possible differences. OBJECTIVES: We explored whether patients' values, ratings, and reports regarding physicians' primary care performance differed by race and/or ethnicity. RESEARCH DESIGN: This was a cross-sectional, mailed patient survey. SUBJECTS: The study subjects were adult primary care patients in a large health maintenance population (7,747 whites, 836 blacks, 710 Latinos, and 1,007 Asians). MEASURES AND METHODS: Ratings of the following dimensions of primary care were measured: technical competence, communication, accessibility, prevention and health promotion, and overall satisfaction. Patients' values regarding these dimensions and their confidence in medical care were measured. Multivariate analyses yielded associations of race/ethnicity with satisfaction and with reports of prevention services received. RESULTS: For 7 of the 10 dimensions of primary care measured, Asians rated physician performance significantly less favorably than did whites, including differences among Asian ethnic subgroups. Latinos rated physicians' accessibility less favorably than did whites. Blacks rated physicians' psychosocial and lifestyle health promotion practices higher than did whites. No differences were found in patient reports of prevention services received, except Pacific Islanders reported receiving significantly more prevention services than whites. CONCLUSIONS: In a large HMO population, significant differences were found by race and ethnicity, and among Asian ethnic subgroups, in levels of patient satisfaction with primary care. These findings may represent actual differences in quality of care or variations in patient perceptions, patient expectations, and/or questionnaire response styles. More research is needed to assess, in accurate and culturally appropriate ways, whether health plans are meeting the needs of all enrollees.