Patient-provider Sex and Race/Ethnicity Concordance: A National Study of Healthcare and Outcomes

Abstract

BACKGROUND: Increasing patient-provider sex and race/ethnicity concordance has been proposed to improve healthcare and help mitigate health disparities, but the relationship between concordance and health outcomes remains unclear. OBJECTIVE: To examine associations of patient-provider sex, race/ethnicity, and dual concordance with healthcare measures. RESEARCH DESIGN AND PARTICIPANTS: Analyses of data from adult respondents indicating a usual source of healthcare (N=22,440) in the 2002 to 2007 Medical Expenditure Panel Surveys (each a 2-year panel). MEASURES: Year 1 provider communication, sex-neutral (colorectal cancer screening, influenza vaccination) and sex-specific (mammography, Papanicolaou smear, prostate-specific antigen) prevention; and year 2 health status (SF-12). Analyses adjusted for patient sociodemographics and health variables, and healthcare provider (usual source of care) sex and race/ethnicity. RESULTS: Of 24 concordance assessments, 3 were statistically significant. Women with female providers were more likely to report mammography adherence [average adjusted marginal effect=3.9%, 95% confidence interval (CI): 1.6%, 6.2%; P<0.01]. Respondents reporting dual concordance were less likely to rate provider communication in the highest quartile (average adjusted marginal effect =-4.2%, 95% CI: -8.1%, -0.2%; P=0.04), but dual concordance was associated with higher adjusted SF-12 Physical Component Summary scores (0.58 points, 95% CI: 0.00, 1.15; P=0.05). CONCLUSIONS: Little evidence of clinical benefit resulting from sex or race/ethnicity concordance was found. Greater matching of patients and providers by sex and race/ethnicity is unlikely to mitigate health disparities.