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Somnath Saha, MD, MPH; Miriam Komaromy, MD; Thomas D. Koepsell, MD, MPH; Andrew B. Bindman, MD

Arch Intern Med. 1999;159:997-1004.

Background  Patients from racial and ethnic minority groups use fewer health care services and are less satisfied with their care than patients from the majority white population. These disparities may be attributable in part to racial or cultural differences between patients and their physicians.

Objective  To determine whether racial concordance between patients and physicians affects patients' satisfaction with and use of health care.

Methods  We analyzed data from the 1994 Commonwealth Fund's Minority Health Survey, a nationwide, telephone survey of noninstitutionalized adults. For the 2201 white, black, and Hispanic respondents who reported having a regular physician, we examined the association between patient-physician racial concordance and patients' ratings of their physicians, satisfaction with health care, reported receipt of preventive care, and reported receipt of needed medical care.

Results  Black respondents with black physicians were more likely than those with nonblack physicians to rate their physicians as excellent (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.55-3.72) and to report receiving preventive care (adjusted OR, 1.74; 95% CI, 1.01-2.98) and all needed medical care (adjusted OR, 2.94; 95% CI, 1.10-7.87) during the previous year. Hispanics with Hispanic physicians were more likely than those with non-Hispanic physicians to be very satisfied with their health care overall (adjusted OR, 1.74; 95% CI, 1.01-2.99).

Conclusions  Our findings confirm the importance of racial and cultural factors in the patient-physician relationship and reaffirm the role of black and Hispanic physicians in caring for black and Hispanic patients. Improving cultural competence among physicians may enhance the quality of health care for minority populations. In the meantime, by reducing the number of underrepresented minorities entering the US physician workforce, the reversal of affirmative action policies may adversely affect the delivery of health care to black and Hispanic Americans.

From the Health Services Research and Development, Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Wash (Dr Saha); Primary Care Research Center, Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco (Drs Komaromy and Bindman); and the Department of Epidemiology, University of Washington, Seattle (Dr Koepsell).

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