Race, gender, and language concordance in the primary care setting

• Published in: International journal of health care quality assurance 2009-06, Vol.22 (4), p.340-352
• Main Authors: Martin, Brian C, Shi, Leiyu, Ward, Ryan D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Child; Child, Preschool; Communication; Concordance; Confidence Intervals; Continental Population Groups; Cross-Sectional Studies; Disadvantaged groups; Ethnic Groups; Ethnic minorities; Female; Gender; Health administration; Health care policy; Health disparities; Health maintenance organizations; Health Policy; Health services; Health Services Accessibility - economics; Health Services Accessibility - standards; Health Services Needs and Demand - economics; Health Services Needs and Demand - standards; HMOs; Humans; Insurance coverage; Language; Male; Minority & ethnic groups; Minority groups; Multivariate Analysis; Odds Ratio; Population; Prejudice; Primary care; Primary health care; Primary Health Care - standards; Race; Resource Allocation; Sex discrimination; Sex Distribution; Socioeconomic Factors; Statistical analysis; United States; United States of America; Variables; Young Adult
• ISSN: 0952-6862; 1758-6542
• DOI: 10.1108/09526860910964816

Purpose - The purpose of this paper is to examine race, gender and language concordance in terms of importance to primary care.Design methodology approach - The 2003 Medical Expenditure Panel Survey Household Component (MEPS) was used. Four distinguishing primary care attributes and selected measures were operationalized primarily from a sample subset that identified a usual source of care (USC): accessibility to USC; interface between primary care and specialist services; treatment decisions; and preventive services received from the USC. Bivariate and multivariate results are reported.Findings - Adjusting for covariates, the following items remained statistically significant: race - choosing primary care physician as USC, USC having office hours, and going to USC for new health problems; gender - choosing primary care physician as USC and USC having office hours; and language - lack of difficulty contacting the USC after hours. However, these items appear to be isolated cases rather than indicators that concordance plays a key role in determining primary care quality. Language barriers communication issues are the only areas where improvement appears warranted.Research limitations implications - While the study has strong accessibility and interpersonal relationship measures, service coordination and comprehensiveness indicators are limited. The analyses' cross-sectional nature also poses a problem in drawing causal relationships and conclusive findings. Finally, sample size limitations preclude stratified analyses across racial ethnic groups, an important consideration as the relationships between concordance and quality may vary across groups.Practical implications - This study indicates that more research is needed in this area to determine future resource allocation and policy direction.Originality value - The unique contribution of the study is to suggest that race and gender concordance may not accurately predict primary health care quality.