Monday, October 19, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS2-49

Anushree Vichare, MBBS, MPH and Tiffany Green, Ph.D, Department of Healthcare Policy and Research, School of Medicine, Virginia Commonwealth University, Richmond, VA
Purpose: Extensive empirical evidence suggests higher satisfaction with care if there is racial concordance between patients and their providers. It is unknown to what extent satisfaction differs among socioeconomic groups, even when racial concordance is achieved. This analysis assesses whether the relationship between provider-patient racial concordance and satisfaction with provider’s communication skills differs by socioeconomic status (SES).

Method: An analytic sample of 32,671 respondents with a usual source of care (USC) was identified using the 2007-2012 Medical Expenditure Panel Survey (MEPS). Patient satisfaction with provider’s communication skills was measured on four dimensions; how often the provider listened carefully, explained medical care in an understandable way, showed respect and spent enough time during consultation. Patients and physician’s race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic and other race. SES was defined using income at federal poverty level (FPL); “low SES” (<200%), “middle SES” (200%-400%) and “high SES” (>400%). Logistic regression models were used to examine the effect of SES on perception of communication skills in racially concordant interactions. 

Result: Approximately 30% of the respondents indicated being racially discordant with their provider; racial discordance was more common among minority and low to middle SES patients. Racial concordance did not have a statistically significant association with higher satisfaction on any measure. Compared to high SES patients, low SES patients were more likely to be dissatisfied in all four domains of provider’s communication skills. The largest differences were detected in satisfaction with provider’s ability to explain medical care (4.5 percentage points, p<0.001). However, perceptions of communication skills did not differ between middle and low SES patients. Additionally, no significant differences were found in the association between race concordance and satisfaction across SES categories.

Conclusion: Vulnerable low SES populations may experience ineffective patient-provider communication even when they have a USC. This can result in greater dissatisfaction with the care received relative to more advantaged populations. Concordance is multidimensional and patient’s perception of similarity to their provider extends to aspects beyond demographic characteristics like personal beliefs and values. With growing emphasis on patient satisfaction scores, a key policy challenge is enhancing physician skills to elicit patient communication preferences that can transcend issues of race and sex to foster positive experiences of care.