The final sample was weighted to correct for the disproportionate sample design and to ensure the sample was representative of all adults aged 18 years and older based on the March 2001 Current Population Survey (CPS). The final weighted sample is therefore reflective of the 193 million adults in the United States who have telephones. A more detailed description of the sampling and weighting methods can be found else-where.11 Data were collected between April 30 and November 5, 2001.
We focus on the subset of questions addressing respondent’s experience with the health care encounter and their use of certain health care services. We used STATA Version 6.012 to conduct statistical analyses using the weighted sample.
Dependent variables
Negative perceptions of the patient-provider relationship. We identified factors that define the patient-provider relationship, and formulated questions based on these factors that would elicit meaningful responses. Specific questions included:
- “Did the doctor treat you with a great deal of respect and dignity, a fair amount, not too much, or none at all?” (4-point scale)
- Please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with the statement, “I often feel as if my doctor looks down on me and the way I live my life.” (4-point scale)
- “Thinking about all of the experiences you have had with health care visits in the last two years, have you ever felt that the doctor or medical staff you saw judged you unfairly or treated you with disrespect because of how well you speak English?” (yes/no)
- “Thinking about all of the experiences you have had with health care visits in the last two years, have you ever felt that the doctor or medical staff you saw judged you unfairly or treated you with disrespect because of your race or ethnic background?” (yes/no)
- “Do you think there was ever a time when you would have gotten better medical care if you had belonged to a different race or ethnic group?” (yes/no)
Those who said they did not have a doctor were unable to answer these questions and were excluded from our analysis. We combined the first 2 questions into a single dichotomous variable, characterized as “being treated with disrespect,” because both questions described negative perceptions of the health care encounter and because doing so preserved sample size for our analyses.
Utilization and optimal care
We examined self-reported use of specific services, including whether respondents had a physical exam within the past year. For cancer screening and chronic disease care, we created variables designed to represent optimal care. For example, optimal cancer screening was defined as being up to date on all tests for which the individual was eligible, based on age and gender.
These included:
- fecal occult blood testing for colon cancer screening within the prior year (both female and male respondents aged >50 years )
- cervical cancer screening within the prior 3 years (all women over the age of the 18)
- mammography within the prior year (women over the age of 50).
We excluded men younger than 50 years since colon cancer screening is not routinely recommended.
We considered respondents to have optimal chronic disease testing if they reported receiving all appropriate testing relevant for their particular condition. For persons with diabetes, this included having a hemoglobin A1c level checked within the past 6 months, a blood pressure check and foot and eye exams within the year, and cholesterol testing within 5 years. For those with heart disease or hypertension, it included having had blood pressure checked within the prior year and cholesterol testing within the prior 5 years. This approach is consistent with that of McBean et al, who have shown that a combination of appropriate tests is more predictive of glycemic control for diabetes.13
Because we were interested in different aspects of patient-initiated care seeking, we also evaluated delay in seeking care and adherence to physician recommendations as further measures of outcome. Specific questions were:
- “During the last 12 months, was there any time when you had a medical problem but put off, postponed, or did not seek medical care when you needed to?”
- “Has there been a time in the last two years when you didn’t follow the doctor’s advice or treatment plan, get a recommended test, or see a referred doctor?” (asked of respondents who had visited a doctor or clinic or had been admitted to the hospital in the last 2 years.)
Analysis
To test our first hypothesis—that persons of racial/ethnic minorities perceive negative experiences with the health care encounter more often than whites or English speakers—we examined