| Current research provides strong evidence that minorities in the U.S. receive significantly lower quality of health care across a range of diseases and disorders e.g.- cancer, cardiac care, and pain management. These findings are particularly salient in light of the significant impact of managed care on health care delivery, reduced patient trust as a result of managed care and the historical distrust of health care institutions by many African Americans, in particular. To better understand the origins of racial disparities in care, the purpose of this dissertation was to determine whether minority patients are experiencing a higher rate of problematic treatment; secondly to determine how minority consumers respond to bad or problematic care (consumer empowerment behaviors); and then thirdly to analyze the impact of consumer expectations about the trustworthiness of physicians and health plans on these events. Data from the Yale/NYAM Consumer Trust in Health Care Survey, a telephone survey conducted in the summer of 2002, were analyzed.; Using multivariate logistic regression, the study found that blacks were significantly more likely to express low levels of trust in physicians and health plans compared to whites. Although black-white differences in the likelihood of experiencing health care problems were not widespread, significant differences were observed for financial access-related problems. Regarding consumer empowerment behaviors, blacks were significantly less likely to voice dissatisfaction to their personal physicians about problematic health care encounters compared to whites. Interestingly, blacks were more likely to "exit" (change physicians or health plans) as a result of negative health care experiences than whites. This type of empowerment behavior may be viewed as futile in many ways; however it does highlight the fact that effective consumer voice may not be a real option for many African American consumers. In light of the low levels of trust in physicians and health plans, these minority consumers may fear retribution, limited system response to their concerns, or disrespectful treatment and alienation for voicing their opinions so they simply exit. The development of culturally relevant consumer empowerment health promotion tools and ombudsperson programs could be very useful for improving self-advocacy by minority patients. |
