摘要：Objectives. This study explored whether racial differences in patient–physician relationships contribute to disparities in the quality of health care. Methods. We analyzed data from The Commonwealth Fund’s 2001 Health Care Quality Survey to determine whether racial differences in patients’ satisfaction with health care and use of basic health services were explained by differences in quality of patient–physician interactions, physicians’ cultural sensitivity, or patient–physician racial concordance. Results. Both satisfaction with and use of health services were lower for Hispanics and Asians than for Blacks and Whites. Racial differences in the quality of patient–physician interactions helped explain the observed disparities in satisfaction, but not in the use of health services. Conclusions. Barriers in the patient–physician relationship contribute to racial disparities in the experience of health care. Numerous studies have demonstrated that the quality of health care in the United States varies according to patients’ race and ethnicity. 1– 5 These studies have consistently found that Blacks and Hispanics receive lowerquality care than the majority White population. Fewer studies have assessed quality of care of other minority groups, including Asians and Native Americans, but those that have done so have generally revealed similar trends. 1, 5 Although some of the observed disparities can be explained by lack of insurance coverage and other impediments to accessing health care services, others persist even in the absence of financial barriers. 1 The root causes of these disparities are not entirely clear. Recently, studies have begun to explore whether barriers in cross-cultural patient–physician relationships may be a contributing factor. These studies have generally found that when compared with White patients, minority patients report lower-quality interactions with their physicians. 6– 9 These differences in the quality of patient–physician relationships appear to be influenced in part by the physicians’ race/ethnicity. Several studies have demonstrated that minority patients, particularly Blacks, tend to prefer physicians of their own race/ethnicity and to rate those physicians as providing better interpersonal care than other-race physicians. 6, 10, 11 Although these studies have demonstrated the impact of patients’ and physicians’ race/ethnicity on the quality of doctor–patient relationships, they have not adequately addressed whether racial differences in the quality of these relationships contribute to other observed disparities in health care quality and ultimately to disparities in health outcomes. 12, 13 To further explore the contribution of the patient–physician relationship to racial disparities in the quality of care, we used data from a national survey to assess the effect of race/ethnicity on patients’ satisfaction with their health care and use of recommended health care services and to determine the degree to which disparities in these measures of health care quality were explained by patient–physician interactions, physicians’ cultural sensitivity, and physicians’ race/ethnicity.
