Despite the deliberate oversampling of major racial/ethnic groups, we remain limited in our ability to examine important subgroups within them, whether related to ethnicity (eg, Cuban, Vietnamese) or chronic condition (eg, asthma, diabetes), even though some groups may differ dramatically from others.
We also had insufficient numbers of Native Americans to analyze separately.
We excluded respondents who did not have a regular doctor because they were unable to answer key questions about the health care encounter.
Finally, there is no agreement on the definition of age-appropriate breast and cervical cancer screening.23, 24 We conducted additional analyses varying the age criteria for testing, including starting the required age for screening at age 40 (for breast cancer) as well as setting the age cut off for required screening at 65 (for both breast and cervical cancer screening), and found that the results were essentially unchanged from those presented. Similarly, adding prostate cancer screening to our models for men over age 50 did not alter our results significantly.
Research should focus on improving perceptions of care
Although it is difficult to quantify or measure negative responses objectively, the strong relationship between patient perceptions of the encounter and utilization suggests an important area for further attention. These findings suggest there may still be a substantial core of individuals who will actively avoid care, perhaps based on previous negative interpersonal experiences in getting care. Interventions aimed at both doctors and potential patients will be required to address this. Research is needed to focus on what approaches can best improve perceptions of care within the patient-provider relationship and how such interventions can reduce racial disparities in health care.
Acknowledgments
This research was done in part by a grant from The Commonwealth Fund.
Corresponding author
Nicole Lurie, MD, MSPH, RAND Corporation, 1200 S. Hayes Street, Arlington, VA 22202. E-mail: lurie@rand.org