The association between perceived provider discrimination, healthcare utilization and health status in racial and ethnic minorities

Ethn Dis. 2009 Summer;19(3):330-7.


Background and objectives: A commonly cited explanation of how racial discrimination impacts health is the biopsychosocial model. However, the biopsychosocial model does not allow for the effects of perceived provider discrimination on health behavior and utilization. In fact, researchers have directed relatively little attention toward the direct and indirect effects of perceived provider discrimination on both healthcare utilization and health status. We, therefore, compared the extent to which perceived provider discrimination explains racial/ethnic differences in healthcare utilization and subsequently health status.

Methods: The data came from the 2001 Survey on Disparities in Quality of Health Care. The final analytic sample was 5,642 adults living in the US. Structural equation modeling evaluated the relationship between perceived provider discrimination, healthcare utilization, and health status.

Results: African Americans, Hispanics and Asians reported significantly more perceived provider discrimination and poorer health compared to non-Hispanic whites. Poor health is significantly mediated by two paths: (1) by perceived provider discrimination and (2) by perceived provider discrimination through unmet need for healthcare utilization.

Conclusions: Perceived provider discrimination contributes to health disparities in African Americans, Hispanics and Asians. Perceived provider discrimination has a direct effect on self-reported health status. Additionally, because minorities perceive more provider discrimination, they are more likely to delay health seeking. In turn, this delay is associated with poor health. This enriches our understanding of how racial/ethnic health disparities are created and sustained and provides a concrete mechanism on how to reduce health disparities.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Asian / statistics & numerical data
  • Attitude of Health Personnel
  • Black or African American / statistics & numerical data
  • Female
  • Health Services / statistics & numerical data*
  • Health Status*
  • Health Surveys
  • Healthcare Disparities
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Models, Theoretical
  • Patient Acceptance of Health Care / ethnology*
  • Physician-Patient Relations*
  • Prejudice*
  • Young Adult