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Differences by Race

Gregory D. Stevens, PhD; Leiyu Shi, DrPH, MPA, MBA

Arch Pediatr Adolesc Med. 2002;156:369-377.

Context  Racial and ethnic disparities in the quality of the patient-provider relationship have been documented previously, but only among adults. Few studies have examined this aspect of primary care quality for children, and none has examined the role of managed care in mediating disparities.

Objective  To explore variations in the associations among 3 managed care policies and the sustained patient-provider relationship for children by racial and ethnic group.

Design, Setting, and Participants  Telephone survey of parents of a random sample of 413 children attending elementary school in a large school district spanning 3 cities in southern California. Self-reported managed care information was validated through contact with health plan representatives.

Main Outcome Measure  Parent reporting of the strength of affiliation and interpersonal relationships among the child, the family, and the health care provider.

Results  Parents of Hispanic and black children reported significantly lower strength of affiliation than whites did (mean, 3.19 and 3.27 vs 3.57; P<.05 and P<.01, respectively). Asians and Hispanics reported significantly poorer interpersonal relationships with providers than whites did (mean, 3.35 and 3.38 vs 3.53; P<.05 for both). Managed care policies requiring patients to (1) sign up with a particular provider, (2) seek a referral for specialty care, and (3) stay within a network were associated with reductions in the interpersonal relationship. All minority groups, but not whites, reported significantly poorer relationships when managed care policies were present. Asian children were most sensitive to the managed care policies.

Conclusions  Our data suggest that racial and ethnic minority children experience poorer patient-provider relationships compared with white children, even controlling for socioeconomic status and health system factors. Minority children are particularly sensitive to managed care policies that restrict patient freedom in choosing where to seek care. Implementing less restrictive policies may enhance the development of the patient-provider relationship.

From the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md.

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