The Association of Racial and Ethnic Concordance in Primary Care with Patient Satisfaction and Experience of Care

Abstract

Background The lack of racial and ethnic concordance between patients and their physicians may contribute to American health disparities.Objective To examine the level of racial and ethnic concordance for patients and primary care clinicians and its association with measures of patient experience.Design Multivariate cross-sectional analysis of nationally representative data.Participants Adults 18 to 64 in the 2019 Medical Expenditure Panel Survey who had at least one medical visit in the past year.Main measures Key independent variables include having a racially/ethnically concordant primary care clinician, lacking a usual source of care, and having a usual source that is a place rather than a person. Outcomes include overall satisfaction with health care, number of medical visits, having enough time in care, ease of understanding the clinician, and receiving respect.Key results The comparison between the actual level of concordance with an expected distribution if all patients had the same probability of having a clinician of a given race or type indicates that Black, Latino, and Asian patients are three or more times as likely to have a concordant clinician than expected, suggesting a strong preference for clinicians of the same race or ethnicity. Racial or ethnic concordance has a modest positive association with overall health care satisfaction and respect but is not significantly associated with the number of medical visits or other outcomes. Poor health status, being uninsured, and lacking a usual source of care are more strongly associated with patient experience.Discussion Efforts to increase the diversity of the primary care workforce could increase racial/ethnic concordance but may have only modest effects on patients' experience of care. Policies like lowering the number of uninsured or increasing those with a usual source of care may be more salient in improving experience of care.