Race and Trust in the Health Care System

Abstract

SYNOPSISObjective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross-sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans.Methods. Respondents ages 18-75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals.Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals.Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.

Variations in Patients' Perceptions and Use of Generic Drugs: Results of a National Survey

“…Educational efforts could be directed at groups that our survey found were of higher risk of skepticism about generic drugs, including non-Caucasian patients and patients with lower socioeconomic statuses. Discrimination that members of certain minority groups and patients with lower socioeconomic status have experienced in the health care system may make such patients less likely to trust an authority figure, such as a physician, 27 offering them something that is just as good, but costs less. Seeking to correct such misperceptions is particularly important because differences in perceptions may lead to underuse of generic drugs among these patients, which can contribute to worse health outcomes and exacerbate health disparities.…”

Understanding the relationship between knowledge and African Americans’ donation decision-making

“…The Tuskegee syphilis study is often cited as a historical event that contributes to African Americans' distrust of the health care establishment [56][57][58][59][60]. It might be the case that this fear and distrust prevents many African Americans from getting necessary treatment, participating in medical research, signing living wills, and donating organs [51,[60][61][62][63][64][65][66]. Indeed, results of this study suggest that concerns about fairness in organ allocation may be central to the donation decision-making process among African Americans.…”

Development of a Revised Health Care System Distrust Scale

“…[1][2][3][4][5] Moreover, health care distrust is commonly cited as an important contributor to racial disparities in health and health care, an issue that has become a national priority for health research and health care delivery. [6][7][8][9][10] Although evidence from other disciplines would suggest that social or institutional trust may play a particularly important role in these relationships, most prior studies of health care have examined trust in personal physicians-a type of interpersonal trust. 11 Relatively few studies have examined institutional or social forms of health care-related distrust, such as distrust of the health care system.…”