Health Care Delivery

Blacks often are less satisfied with their health care, perhaps because they feel "socially distant" from their doctors

Blacks usually are less satisfied with their doctors and health care than whites. This may be due in part to their greater "social distance" from their doctors compared with whites, suggests a study supported in part by the Agency for Healthcare Research and Quality (HS09894). Doctors are highly educated, usually have higher incomes, tend to come from upper class families, and seldom are black. White patients are more likely than black patients to have similar socioeconomic status and race as their doctors and thus less social distance from them, which can lead to more satisfying interaction, explains Jennifer Malat, Ph.D., of the University of Cincinnati.

Dr. Malat analyzed data from the 1995 Detroit Area Study, in which 1,140 adults (586 were black) were asked to rate their doctor from poor to excellent on respectful treatment and time spent with them during their last office visit. More than 64 percent of whites rated their doctor as excellent on respect and time, but only 47 percent of blacks conferred a similar rating; 46 percent of whites and 35 percent of blacks rated their doctor as excellent on time spent with them. Increasing per capita household income was associated with increasing likelihood of reporting more respectful treatment and time spent. The relationship between educational level and time was not significant. However, the least educated individuals were most likely to report excellent respect (perhaps due to lower expectations of how much respect doctors should show them).

Those who visited a doctor of their race rated their provider higher on both respect and time, but the relationship was significant only for respect. Overall, whites were almost twice as likely as blacks to rate their doctors highly for respect, even after controlling for other factors such as age, health status, and source of care. The race effect for time was lower but still significant. Overall, the socioeconomic status variables reduced the coefficient for race by 24 percent in the model predicting respect and by 28 percent in the model predicting time.

See "Social distance and patients' rating of healthcare providers," by Dr. Malat, in the December 2001 Journal of Health and Social Behavior 42, pp. 360-372.

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