Disparities in service quality among insured adult patients seen in physicians' offices

Objective: To examine racial disparities in health care service quality. Design: Secondary data analyses of visits by primary care service users in the Community Tracking Study household sample. Setting: Sixty communities across the United States. Participants: A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996-1997, 1998-1999, 2000-2001, and 2003. Measurements: Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed. Results: Blacks but not other minorities were more likely to have an appointment lag of more than 1 week (13% white vs. 21% black, p < 0.001). Blacks, Hispanics, and other minorities were more likely to wait more than 30 min before being seen by the physician (16% white vs. 26% black, p < 0.001; vs. 27% Hispanic and 22% other minority, p < 0.001 and p = 0.02, respectively) and were less likely to report that they were very satisfied with their care (65% white vs. 60% black, p = 0.02; vs. 57% Hispanic and 48% other minority, p = 0.004 and p < 0.001, respectively). The differences in appointment lag and wait time remain large and statistically significant after the inclusion of multiple covariates, including geographic controls for CTS site. For all groups, satisfaction with care was affected by objective measures of service quality. Differences in objective measures of service quality explained much of the black-white difference in satisfaction, though not differences for other minority groups. Conclusion: There are substantial racial/ethnic disparities in satisfaction with care, and these are related to objective quality measures that can be improved.