Racial Disparities in Access to Care for Men in a Public Assistance Program for Prostate Cancer
Published In: Journal of Community Health, v. 33, no. 5, Oct. 2008, p. 318-335
Posted on RAND.org on December 31, 2007
California's IMPACT program provides all its enrollees with health insurance and social service resources. The authors hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Their objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. The authors performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. The authors evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. They also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. The authors observed significant bivariate associations between race/ethnicity and patient-experience outcomes (P\0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR = 5.15, 95% CI 1.17-22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P = 0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. They observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.