“Are you accepting new patients?” A pilot field experiment on telephone‐based gatekeeping and Black patients’ access to pediatric care

• Published in: Health services research 2019-02, Vol.54 (1), p.234-242
• Main Authors: Leech, Tamara G.J., Irby‐Shasanmi, Amy, Mitchell, Anne L.
• Format: Article
• Language: English
• Subjects: Accentuation; Acceptance tests; access/demand/utilization of services; African Americans - ethnology; African Americans - statistics & numerical data; Audits; Child; child and adolescent health; Child health; Child Health Services - organization & administration; Children; Comparative analysis; Cues; determinants of health/population health/socioeconomic causes of health; Discrimination; Family medicine; Gatekeeping - statistics & numerical data; General practice; Health aspects; Health care access; Health Equity; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Humans; Insurance; Insurance, Health - statistics & numerical data; Medical offices; Office workers; Offices; Patients; Pediatrics; Physicians; Pilot Projects; Profiles; Qualitative analysis; Qualitative Research; Quasi-experimental methods; racial/ethnic differences in health and health care; Racism; Regional differences; Regional variations; Regions; Social aspects; sociology; Special Issue: Health Equity; Systemic racism; Telephone; Telephone calls
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.13089

Study Objectives To determine whether name and accent cues that the caller is Black shape physician offices’ responses to telephone‐based requests for well‐child visits. Method and Data In this pilot study, we employed a quasi‐experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind‐coded into binary variables. Our case‐control comparisons using McNemar's tests focused on acceptance of patients, withholding information, shaping conversations, and misattributions. Findings Compared to the control group, “Black” auditors were less likely to be told an office was accepting new patients and were more likely to experience both withholding behaviors and misattributions about public insurance. The strength of associations varied according to whether the cue was based on name or accent. Additionally, the likelihood and ways office personnel communicated that they were not accepting patients varied by region. Conclusions Linguistic profiling over the telephone is an aspect of structural racism that should be further studied and perhaps integrated into efforts to promote equitable access to care. Future research should look reactions to both name and accent, taking practice characteristics and regional differences into consideration.