Health Care Utilization and Patient-Provider Racial/Ethnic Concordance Among Asian American Subgroups

This study aimed to apply Andersen's behavioral model of health services to examine the association of patient-provider racial and ethnic concordance on health care use within Asian American subgroups with a focus on nativity.

We estimate multivariate probit models using data from the Medical Expenditure Panel Survey. We collect and utilize data on preventive care visits, visits for new health problems, visits for ongoing health problems, and number of doctor's visits from survey years 2013-2017 to measure health utilization. Additionally, we include data on racial and ethnic concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis to capture predisposing, enabling, and need factors. Our sample includes 61,667 observations, mainly White respondents (86.2%) with 3.0% Indian American respondents, 3.1% Chinese American respondents, 2.3% Filipino American respondents, and 5.4% respondents classified in the survey as Other Asians. A total of 3% (1847) of the cases in the sample involved Asian provider-patient concordance.

Our study provides evidence of differences in health utilization within Asian subgroups even after controlling for enabling, need, and other predisposing factors. Namely, Asian American patient-provider concordance is associated with statistically significant increases in the probabilities of seeking preventive care, seeking care for a new problem, and seeking care for an ongoing problem, relative to Asian American patients with non-Asian American providers. We also find that the association is not equal across the Asian American subgroups. The Asian American patient-provider concordance is consistently positive and significant for Chinese Americans. For the number of provider visits, the association is only positive and significant for foreign-born Chinese American patients.

The overall results support the positive association between the predisposing factor of Asian patient-provider race concordance and health care utilization. Moreover, patient-provider concordance is particularly important for the Chinese subgroup, which is less likely to seek medical care relative to White patients. The findings suggest that the diversity in the Asian population should be taken into account when designing outreach programs, particularly for non-US-born patients.