Abstract
OBJECTIVES: To determine: 1) whether racial and ethnic differences exist in patients’ perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables.
DESIGN: Cross-sectional telephone survey.
SETTING: The Commonwealth Fund 2001 Health Care Quality Survey.
SUBJECTS: A total of 6,299 white, African-American, Hispanic, and Asian adults.
MEASUREMENTS AND MAIN RESULTS: Interviews were conducted using random-digit dialing; oversampling respondents from communities with high racial/ethnic minority concentrations; and yielding a 54.3% response rate. Main outcomes address respondents’ perceptions of their PCPs’ and health care system-related bias and cultural competence; adjusted probabilities (Pr) are reported for each ethnic group. Most racial/ethnic differences in perceptions of PCP bias and cultural competence were explained by demographics, source of care, and patient-physician communication variables. In contrast, racial/ethnic differences in patient perceptions of health care system-wide bias and cultural competence persisted even after controlling for confounders: African Americans, Hispanics, and Asians remained more likely than whites (P<.001) to perceive that: 1) they would have received better medical care if they belonged to a different race/ethnic group (Pr 0.13, Pr 0.08, Pr 0.08, and Pr 0.01, respectively); and 2) medical staff judged them unfairly or treated them with disrespect based on race/ethnicity (Pr 0.06, Pr 0.04, Pr 0.06, and Pr 0.01, respectively) and how well they speak English (Pr 0.09, Pr 0.06, Pr 0.06, and Pr 0.03, respectively).
CONCLUSION: While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57(suppl 1):108–45.
Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003.
Cooper LA, Roter DL. Patient-Provider Communication. The Effect of Race and Ethnicity on Process and Outcomes of Healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academy Press; 2003:552–93.
Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.
Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159:997–1004.
Gross DA, Zyzanski SJ, Borawski EA, Cebul RD, Stange KC. Patient satisfaction with time spent with their physician. J Fam Pract. 1998;47:133–7.
Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14:82–7.
Malat J. Social distance and patients’ rating of healthcare providers. J Health Soc Behav. 2001;42:360–72.
Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care. 2002;40(suppl 1):I27-I34.
Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from The Commonwealth Fund 2001 Health Care Quality Survey. New York: The Commonwealth Fund; 2002.
Blendon RJ, Scheck AC, Donelan K, et al. How white and African-Americans view their health and social problems. J Am Med Assoc. 1995;273:341–6.
Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.
van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–28.
Taylor JS. Confronting ‘culture’ in medicine’s ‘culture of no culture’. Acad Med. 2003;78:555–9.
Kagawa-Singer M, Kassim-Lakha S. A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med. 2003;78:577–87.
Wear D. Insurgent multiculturalism: rethinking how and why we teach culture in medical education. Acad Med. 2003;78:549–54.
van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93:248–55.
Health Resources and Services Administration Bureau of Health Professions, USDHHS. BHPR — Other Definitions of Cultural Competence. Available at: http:/bhpr.hrsa.gov/diversity/cultcomp.htm. Accessed August 21, 2003.
Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118:293–302.
United States Department of Health and Human Services, Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, March 1 2001. United States Department of Health and Human Services, OPHS, Office of Minority Health; 2001.
Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. Available at: http://www.lcme.org/functions2003july.pdf. Accessed January 19, 2004.
Dolhun EP, Munoz C, Grumbach K. Cross-cultural education in U.S. medical schools: development of an assessment tool. Acad Med. 2003;78:615–22.
Cooper LA, Hill MN, Powe NR. Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. J Gen Intern Med. 2002;17:477–86.
Stata Statistical Software. College Station, Tex: Stata Corporation; 2001.
Betancourt JR, Green AR, Carrillo JE. Cultural competence in Health Care. Emerging Frameworks and Practical Approaches, 10-1-2002. The Commonwealth Fund. Quality of Care for Underserved Populations Field Report.
Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829–34.
Campinha-Bacote J. A model and instrument for addressing cultural competence in health care. J Nurs Educ. 1999;38:203–7.
Zweifler J, Gonzalez AM. Teaching residents to care for culturally diverse populations. Acad Med. 1998;73:1056–61.
Lurie N, Yergan J. Teaching residents to care for vulnerable populations in the outpatient setting. J Gen Intern Med. 1990;5(suppl 1):S26-S34.
Berlin EA, Fowkes WC Jr. A teaching framework for cross-cultural health care. Application in family practice. West J Med. 1983;139:934–8.
Ngo-Metzger Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18:44–52.
Tucker CM, Herman KC, Pedersen TR, Higley B, Montrichard M, Ivery P. Cultural sensitivity in physician-patient relationships. Perspectives of an ethnically diverse sample of low-income primary care patients. Med Care. 2003;41:859–70.
Stewart AL, Napoles-Springer A, Perez-Stable EJ, et al. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77:305–39, 274–339.
Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57(suppl 1):181–217.
Keeter S. Estimating telephone noncoverage bias with a telephone survey. Public Opin Q. 1995;59:196–217.
Williams DR, Neighbors HW, Jackson JS. Racial/Ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93:200–8.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was supported by a research grant from the Common-wealth Fund. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.
Rights and permissions
About this article
Cite this article
Johnson, R.L., Saha, S., Arbelaez, J.J. et al. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J GEN INTERN MED 19, 101–110 (2004). https://doi.org/10.1111/j.1525-1497.2004.30262.x
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2004.30262.x