Race and trust in the health care system
Race and trust in the health care system
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DOI：
10.1016/s0033-3549(04)50262-5
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发表时间：
2003-07-01
影响因子：
3.3
通讯作者：
Powe, NR
中科院分区：
文献类型：
--
作者：
Boulware, LE;Cooper, LA;Powe, NR
客观的。医学研究和医疗保健系统中遗留的种族歧视与非裔美国人对医学研究和医疗保健的信任度较低有关。虽然对医生的信任度存在种族差异，但人们对健康保险计划和医院的信任度的种族差异却知之甚少。在本研究中，作者分析了一项横断面电话调查的答复，以评估自我报告的种族（非西班牙裔黑人或非西班牙裔白人）与对医生、医院和健康保险计划的信任之间的独立关系。方法。年龄在 18-75 岁之间的受访者被要求评价他们对医生、健康保险计划和医院的信任程度。医疗不信任指数中的项目用于评估对医院的恐惧和怀疑。结果。对 49 名非西班牙裔黑人 (42%) 和 69 名非西班牙裔白人 (58%) 受访者的回答进行了分析（N=118；占调查总人口的 94%）。大多数受访者信任医生（71%）和医院（70%），但信任他们的健康保险计划的人较少（28%）。在调整潜在的混杂因素后，非西班牙裔黑人受访者比非西班牙裔白人受访者更不可能信任他们的医生（调整后的绝对差异 37%；p=0.01），并且更有可能信任他们的健康保险计划（调整后的绝对差异 28%；p=0.04）。对医院的信任度差异（调整后的绝对差异13%）没有统计学意义。非西班牙裔黑人受访者比非西班牙裔白人受访者更有可能担心个人隐私和医院进行有害实验的可能性。结论。对我们医疗保健系统组成部分的信任模式因种族而异。信任的差异可能反映了黑人和白人不同的文化经历以及对护理的期望的差异。如果要有效地提高患者获得护理的机会和对护理的满意度，就需要加深对这些因素的了解。
Objective. 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.