Smith, I. I. I. (2010). Racial and Gender Concordance: Effects on Utilization of Health Services Among Individuals Enrolled in a Primary Care Case Management Delivery System. Unc Charlotte Electronic Theses And Dissertations.
Very few studies to date have directly examined the impact of race or gender patient-provider concordance on the utilization of health services. This is particularly noteworthy given the role that the linkage between concordance and health service utilization may play in the eradication of race- and gender-based health disparities. This dissertation, grounded on the theory of Andersen's (1995) Emerging Model of Health Services Utilization (Phase Four), used data collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid's primary care case management managed care delivery system to study this phenomenon. The data were obtained from two sources: (1) a computer assisted telephone survey of 2,815 respondents that used the North Carolina Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 Adult Survey 2006 as the survey instrument and, (2) enrollment data provided by plan administrators. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and gender concordance, respectively, to establish a post-test only comparison research design. The utilization of five different forms of health services - primary care, specialty care, emergency care, inpatient care, and prescription drugs - were analyzed using factor analysis, ordinary least squares linear regression, and logistic regression methodologies. The key findings are that race and gender patient-primary care provider concordance did not directly impact the utilization of primary, specialty, emergency, or inpatient care. However, concordance between patient and primary care provider was demonstrated to decrease the likelihood of using prescription drugs. The research, which is unique in its ability to control for socioeconomic and health insurance status, informs policymakers and other stakeholders tasked with allocating resources that impact the utilization of health services and other health outcomes in the quest to eliminate race- and gender-based health disparities.