| Despite improvements in medical technology and increased availability of health care, blacks have continued to suffer excess mortality for a number of common health conditions. Although many factors have been examined to explain the disparities that continue to exist between blacks and whites, less work has evaluated the role of perceived discrimination in contributing to these differences. The purpose of this dissertation is to examine the various ways in which discrimination can impact health care use.; This dissertation uses data from the Commonwealth Fund 2001 Health Care Quality Survey specifically focusing on key measures of perceived discrimination as well as measures of health care utilization. These measures included feelings of being treated with disrespect or being looked down upon, perceptions of receipt of unfair treatment due to race or language spoken, and beliefs that better treatment would have been received had the respondent had been of a different race. Measures of utilization included receipt of a physical exam within the prior year, receipt of optimal cancer screening and recommended elements of chronic disease care, delay of needed care and the decision to not follow the doctor's advice. Minorities were significantly more likely than whites to report being treated with disrespect or being looked down upon in the patient-provider relationship. Persons who thought that they would have received better treatment if they were of a different race were significantly less likely to receive optimal chronic disease screening and more likely not to follow the doctor's advice or put off care. Racial concordance of patient and provider (i.e. concordance being defined as whether a patient and provider were of the same racial background) did not affect whether a patient perceived being treated with respect in the patient-provider setting.; Identifying policy initiatives to reduce rates of perceived discrimination in the health care setting is a challenging goal which must be multifactorial in nature. While improving the numbers of minority providers in the health care setting is critical, the Commonwealth Fund data suggest that this is not the only pathway that must be addressed. |
