National Healthcare Disparities Report 2004

Patient Perceptions of Care

Patient-Provider Communication

Accessing health care does not guarantee optimal care if patients and providers do not communicate effectively. Barriers to patient-provider communication are common. About 47 million people speak a language other than English at home; almost half do not speak English very well¹⁸. A fifth of Americans score at the lowest level of literacy and another quarter score at the next level; understanding health information often requires literacy skills above these levels¹⁹. Health literacy, the "capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions²⁰," may be an even bigger problem. People with low literacy have less understanding of their medical conditions and health care^21,22, worse health status²³, higher use of emergency and inpatient services, and lower adherence to medications and participation in medical decisionmaking²⁴. Estimates of health expenditures attributable to low health literacy range from $29 billion to $69 billion per year²⁵. Providers also differ in communication proficiency; variation in listening skills has been noted.

Figure 3.7. Adults whose providers sometimes or never listen carefully to them by race, ethnicity, and income, 2000-2001

Figure 3.7. Adults whose providers sometimes or never listen carefully to them by race, ethnicity, and income, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medical Expenditure Panel Survey, 2000-2001.

Reference population: Civilian, noninstitutionalized people age 18 and over.

Note: For findings related to all measures of patient-provider communication, see Tables 3.3a and 3.3b.

In 2001, the proportion of adults with providers who sometimes or never listen carefully was higher among API compared with white, Hispanic compared with non-Hispanic white, and poor, near poor, and middle income compared with high income adults; black-white differences were not noted.
Between 2000 and 2001, rates of adults with providers who sometimes or never listen carefully did not change significantly among any groups.
In multivariate models controlling for age, gender, income, education, insurance, and residence location, the difference between Hispanic and non-Hispanic whites is attenuated, but other differences persist. APIs are 73% more likely than whites to have providers who sometimes or never listen carefully. Compared with high income adults, poor, near poor, and middle income adults are 52%, 56%, and 37% more likely to have providers who sometimes or never listen carefully, respectively.

Patient-Provider Relationship

The patient-provider relationship is built upon mutual respect, trust, and understanding. Patient perceptions of the strength of this relationship may be reflected in patient satisfaction and ratings of health care. The first NHDR reported that many racial and ethnic minority groups as well as low SES groups are more likely to rate their overall health care poorly.

Figure 3.8. Adults who rate their health care in the past year less than 7 on a scale from 0 to 10 by race, ethnicity, and income, 2000-2001

Figure 3.8. Adults who rate their health care in the past year less than 7 on a scale from 0 to 10 by race, ethnicity, and income, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medical Expenditure Panel Survey, 2000-2001.

Reference population: Civilian, noninstitutionalized people age 18 and over.

Note: For findings related to all measures of the patient provider relationship, see Tables 3.3a and 3.3b.

In both 2000 and 2001, the proportion of adults who rate their health care less than 7 on a scale from 0 (worse health care possible) to 10 (best health care possible) was higher among black compared with white adults; Hispanic compared with non-Hispanic white adults; and poor, near poor, and middle income compared with high income adults (Figure 3.8).
The proportion of adults who rate their health care less than 7 was also higher among AI/AN compared with white adults in 2001 (there were too few AI/AN adults to provide a reliable estimate in 2000).
Between 2000 and 2001, the proportion of adults who rate their health care less than 7 declined among white, API, non-Hispanic white, and high income adults.
In multivariate models controlling for age, gender, income, education, insurance, and residence location, all racial and ethnic differences are attenuated, but income-related differences persist. Compared with high income adults, poor, near poor, and middle income adults are 66%, 60%, and 44% more likely to rate their health care less than 7.