Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Background & Motivation Recognizing the urgent need to address racial/ethnic disparities in quality and access of care, the Institute of Medicine (Smedley et al; 2003), the American College of Physicians (Lightner, 2004) and several other researchers (Carlisle et al; 1998; Cohen, 2003; Laveist et al; 2003; Salsberg & Forte, 2002) have recommended that policymakers help increase a racially concordant workforce of minority providers in the United States. Since the U.S. population is expected to grow from 18% of ethnic minorities in 2000 to about 23% by 2020, the minority provider's workforce would have to be expanded substantially to be racially concordant. As a result, wages for minority providers would certainly have to be increased to meet any patient-provider racial concordance goals (Weiner, 2007; Starfield et al., 2005; Baicker & Chandra, 2004). Although several studies have shown that minority patients have reported greater satisfaction (Saha et al; 1999; LaVeist & Nuru-Jetter, 2002, Cooper et al., 2003) when receiving care from racially-concordant providers, no studies have examined the effects of changes in a racially patient-physician racially concordant workforce on cost and quality.

Brown et al (2007) confirmed that the market is willing to pay a premium for the wage rate when the share of patient-physician racially concordant workforce in an area is small. But this study did not examine the impact of the wage premiums on the supply of racially-concordant physicians and its subsequent effects on the quality of care received by minority patients. As Heyes (2005) posits, any increase in the wage rate to attract more providers would decrease the average quality of the workforce. The current study plans to test this hypothesis on the expected increase of a racially/ethnically concordant workforce of physicians by investigating the effects of changes in a patient-physician racially concordant workforce on the average quality of care received by minority patients. Specifically, this study aims to answer the following related questions: a) how do changes in a racially/ethnically concordant workforce of patients and physicians impact the quality of care received by minority patients with diabetes? b) how do changes in a racially/ethnically concordant workforce of patients and physicians impact the satisfaction level of care reported by minority patients?

Study Designs & Methods: Heyes (2005) posits that increases in nurses' wages decrease the share of nurses with 'vocation' and therefore, the average quality of care received by patients. This analysis intends to use a modified version of this model to reflect the labor market structure of a patient-physician racially/ethnically concordant workforce.

The study plans to use data from the 2002- 2005 Medical Expenditure Panel Survey (MEPS) on adults from 18-64 years old. Outcomes of interest are rates of change of a Quality Index of Diabetes care received by patients and rates of change of a Satisfaction Index as reported by patients. Fixed effects linear probability (OLS with fixed effects) and Weighted Least Squares (WLS) models that control for unobserved variables and clustering effects will be used to estimate the parameters of interest.

Policy Implications: The findings of this study would help researchers and policymakers understand better the benefits/limitations of racial concordance in improving the quality of care received by minority patients.