The role of race concordance on prescription drug utilization among primary care case-managed Medicaid enrollees

Abstract

Background: The race concordance hypothesis suggests that matching patients and health providers on the basis of race improve communication and patients' perceptions of health care, thereby encouraging patients to seek and utilize health care. However, few studies have examined the direct impact of race concordance on the utilization of prescription drugs.

Objectives: This paper, grounded in the theory of Andersen's Emerging Model of Health Services Utilization (Phase Four), includes race concordance between patients and their primary care providers as a predisposing characteristic and examines its effect on prescription drug utilization. Drug utilization was analyzed in terms of aggregated race concordance and dis-aggregated (stratified) race concordance.

Methods: This study examines the experience of 1942 adults enrolled in North Carolina Medicaid's managed care delivery system in 2006-2007. Primary data were obtained from a computer assisted telephone survey that used the North Carolina Medicaid CAHPS 3.0 Adult Survey 2006 as the survey instrument and from enrollment data provided by plan administrators. Propensity score matching techniques sorted respondents on their propensity for race concordance and indices were constructed from survey indicators to generate key control variables. A nested logistic regression model analyzed prescription drug utilization.

Results: The primary findings indicate that race concordance between survey respondents and primary care providers was not a significant predictor of prescription drug use when examining aggregated concordance, but was significant in the black concordant subgroup.

Conclusions: The contradictory findings in the white and black subpopulations suggest that additional studies at the subpopulation level are required to resolve this dilemma. These studies should employ path analysis or structural equation modeling to examine the relationship between patients' trust, satisfaction, and race concordance with their providers. The current study makes a valuable contribution to the sparse body of literature describing the impact of race concordance on prescription drug use.

Keywords: Medicaid; Prescription drug use; Race concordance; Satisfaction; Trust.