Acculturation, Hispanic ethnicity, and trust: Verifying and explaining racial/ethnic differences in trust in health providers in North Carolina Medicaid.

Three North Carolina Medicaid surveys conducted from 2000 to 2012 reported increasing numbers of Hispanic children enrolled in Medicaid and much lower trust in providers expressed by their adult caregiver respondents compared with responses for non-Hispanic Black and White children. To verify and explain this apparent trust chasm, we used bivariate and regression analyses. The variables employed included trust (dependent variable); child's race/ethnicity, age, and sex; satisfaction and health status scales; two utilization measures; respondent's age, sex, and education; geographical region; and population density of county of residence. Race/ethnicity was strongly associated with trust (p < .001), controlling for other independent variables. Access, satisfaction, and respondent's age and education were also significant. Our results fit the Behavioral Model for Vulnerable Populations, which maps the role of significant variables in health-seeking behavior. After analyzing the concept of trust, we argue that lower acculturation explains lower Hispanic trust compared with non-Hispanic Blacks. We suggest policies to improve acculturation.

Physicians, Physician Extenders and Health Outcomes: Race, Gender and Patient-Health Provider Concordance in North Carolina Medicaid.

BACKGROUND: No studies were found that consider the role of race and gender concordance in patient-physician extender relationships. METHODS: A telephone survey in summer 2012 allowed measures of the relationship between physicians and physician extenders with race and gender concordance. Randomized stratified sampled adults (n = 1,401) enrolled in North Carolina Medicaid's managed care networks met the study's criteria. FINDINGS: The analysis determined the association of provider type and race and gender concordance. It also explored the association of race and gender concordance with trust, satisfaction, and decision-making propensity. Separate logistic regression models were constructed for each dependent variable. Race concordance was associated with significantly higher trust scores among respondents in the physician subgroup when race was not included in the predictive model. However, in those models where race and gender were included as control variables, provider type was not associated with race and gender concordance in the logistic regressions.

Is physician-patient concordance associated with greater trust for women of low socioeconomic status?

The authors examined the association between physician-patient concordance and patient trust for low socio-economic status women who were enrolled in Medicaid case management. The data were collected from October 2006 through March 2007 from a stratified random sample of 2,815 adult beneficiaries enrolled in North Carolina Medicaid's primary care case management delivery system. We limited our analyses to women enrolled in primary care, hence controlling for gender and social class as well as access to care. We were also able to control for the availability of minority providers. The findings revealed that the enrollee's race, education, and experiences seeking help with their health providers were significantly related to patient's trust of their physicians. Neither race concordance nor gender concordance improved trust. This may be because relatively few minority providers were included in the sample. These results extend research on physician-patient concordance by examining the relationship of both racial and gender concordance with patient trust while controlling for access and social class. Research on physician-patient concordance needs to account for multiple measures of social status, as well as differences in culture and communication styles between physicians and their patients.

The role of race concordance on prescription drug utilization among primary care case-managed Medicaid enrollees.

BACKGROUND: The race concordance hypothesis suggests that matching patients and health providers on the basis of race improve communication and patients' perceptions of health care, thereby encouraging patients to seek and utilize health care. However, few studies have examined the direct impact of race concordance on the utilization of prescription drugs. OBJECTIVES: This paper, grounded in the theory of Andersen's Emerging Model of Health Services Utilization (Phase Four), includes race concordance between patients and their primary care providers as a predisposing characteristic and examines its effect on prescription drug utilization. Drug utilization was analyzed in terms of aggregated race concordance and dis-aggregated (stratified) race concordance. METHODS: This study examines the experience of 1942 adults enrolled in North Carolina Medicaid's managed care delivery system in 2006-2007. Primary data were obtained from a computer assisted telephone survey that used the North Carolina Medicaid CAHPS 3.0 Adult Survey 2006 as the survey instrument and from enrollment data provided by plan administrators. Propensity score matching techniques sorted respondents on their propensity for race concordance and indices were constructed from survey indicators to generate key control variables. A nested logistic regression model analyzed prescription drug utilization. RESULTS: The primary findings indicate that race concordance between survey respondents and primary care providers was not a significant predictor of prescription drug use when examining aggregated concordance, but was significant in the black concordant subgroup. CONCLUSIONS: The contradictory findings in the white and black subpopulations suggest that additional studies at the subpopulation level are required to resolve this dilemma. These studies should employ path analysis or structural equation modeling to examine the relationship between patients' trust, satisfaction, and race concordance with their providers. The current study makes a valuable contribution to the sparse body of literature describing the impact of race concordance on prescription drug use.