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Blacks and Hispanics receive worse care than whites, yet rate their interactions with health care providers more positively

Blacks and Hispanics receive significantly worse medical care than whites in the United States, yet they rate their interactions with health care providers more positively than whites, according to a new study by researchers at the Agency for Healthcare Research and Quality. Elizabeth Dayton, M.A., and colleagues examined findings from the National Healthcare Disparities Report released by AHRQ in February 2005.

The study reveals that blacks received significantly worse care than whites did in 68 percent of clinical quality measures and 35 percent of care access measures, while receiving better care for none of the quality measures and 10 percent of access measures. Hispanics received significantly poorer care than whites did for 50 percent of quality measures and 90 percent of access measures, while receiving better care for 11 percent of quality measures and 3 percent of access measures.

Yet across the board, blacks and Hispanics were more likely than whites to assess their care experiences positively. They reported that their providers always listened carefully, explained things in a way they could understand, and showed respect for what they had to say.

Several factors could explain these seemingly contradictory findings. Responses by black and Hispanic patients may reflect different understandings of survey items or different response tendencies (for example, to pick "always" or "never" responses instead of more moderate responses such as "usually") rather than actual disparities in experience. Second, the varied beliefs, attitudes, and experiences that are shared by some racial/ethnic groups likely shape their expectations and resulting assessments of care. Finally, race/ethnicity often serves as a proxy for interrelated social, economic, and cultural characteristics. Future studies of racial/ethnic disparities in care should account for these factors in order to minimize sources of bias, caution the researchers.

More details are in "Racial and ethnic differences in patient assessments of interactions with providers: Disparities or measurement biases?" by Ms. Dayton, Chunliu Zhan, M.D., Ph.D., Judith Sangl, Sc.D., and others, in the March 2006 American Journal of Medical Quality 21(2), pp. 109-114. Reprints (AHRQ Publication No. 06-R049) are available at the AHRQ Publication Clearinghouse.

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