Speaking Up and Walking Out: Are Vulnerable Patients Less Likely to Disagree With or Change Doctors?. Issue 9 (September 2018)

• Record Type: Journal Article
• Authors: Martino, Steven C.; Elliott, Marc N.; Mallett, Joshua S.; Orr, Nate; Gaillot, Sarah; Haviland, Amelia M.
• Is Part Of: Medical care. Volume 56:Issue 9(2018)
• Publication Date: 2018-09
• Subjects: CAHPS -- doctor-switching -- Medicare -- patient agency -- physician-switching -- social risk factors -- vulnerable populations; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000936
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities. Objective: To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population. Subjects: Fee-for-service beneficiaries (N=96, 317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity. Methods: Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0–100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location. Results: Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors ( P <0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (−9.5) and Hispanic (−3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (−8.7), Hispanic (−5.9), and American Indian/Alaska Native (−3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors ( P <0.01). Discussion: Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor. Abstract : Supplemental Digital Content is available in the text.