Race, gender, and language concordance in the primary care setting.
OBJECTIVE
The purpose of this paper is to examine race, gender and language concordance in terms of importance to primary care.


METHODS
The 2003 Medical Expenditure Panel Survey Household Component (MEPS) was used. Four distinguishing primary care attributes and selected measures were operationalized primarily from a sample subset that identified a usual source of care (USC): accessibility to USC; interface between primary care and specialist services; treatment decisions; and preventive services received from the USC. Bivariate and multivariate results are reported.


RESULTS
Adjusting for covariates, the following items remained statistically significant: race--choosing primary care physician as USC, USC having office hours, and going to USC for new health problems; gender--choosing primary care physician as USC and USC having office hours; and language--lack of difficulty contacting the USC after hours. However, these items appear to be isolated cases rather than indicators that concordance plays a key role in determining primary care quality. Language barriers/communication issues are the only areas where improvement appears warranted.


CONCLUSIONS
While the study has strong accessibility and interpersonal relationship measures, service coordination and comprehensiveness indicators are limited. The analyses' cross-sectional nature also poses a problem in drawing causal relationships and conclusive findings. Finally, sample size limitations preclude stratified analyses across racial/ethnic groups, an important consideration as the relationships between concordance and quality may vary across groups.


CONCLUSIONS
This study indicates that more research is needed in this area to determine future resource allocation and policy direction.


CONCLUSIONS
The unique contribution of the study is to suggest that race and gender concordance may not accurately predict primary health care quality.
Martin
Brian C
BC
Department of Health Services Administration, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA. martinb@etsu.edu
Shi
Leiyu
L
Ward
Ryan D
RD
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D006301:Health Services Needs and Demand / Q000191:economics / Q000592:standards*; D006801:Humans; D007802:Language; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011287:Prejudice; D011320:Primary Health Care / Q000592:standards*; D044469:Racial Groups; D040841:Resource Allocation; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult