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Doctors who treat Latinos aren't confident they can provide the best care

Photo by Seattle Municipal Archives/Flickr (Creative Commons)

Disparities in medical services have long landed minorities on the losing end of the health care system, with several studies documenting the lack of quality care experienced by many black Americans. And it's no better for Latinos, new research out of UCLA and City University of New York shows.

The study, whose results are featured in the new edition of Health Affairs, focused on health providers who treat Latino patients. What researchers found is that physicians who treat primarily Latino patients, as compared with those whose patients are primarily non-Latino whites, are less likely than their peers to believe they are able to provide patients with high-quality care.

Among the reasons these doctors cited: inadequate time with patients, their patients' lack of ability to afford health care, communication difficulties, a relative lack of available specialists, a lack of timely transmission of medical reports, and patients' failure to adhere to recommended treatments, the latter not surprising for patients on a tight budget.

Another interesting finding: The doctors more likely to treat non-Latino white patients (the "reference group") differed substantially from those who treat Latinos in terms of ethnicity, education, and how they derive their income. From the report:

Physicians in the reference group were more likely than those in the comparison group to be male, white, board certified, and US educated, and they had an average of eighteen years’ experience. Three-fourths of reference- group physicians worked in either group or individual practices, and more than half were in practices that they owned fully or in part.

A majority of reference-group physicians (52 percent) earned less than $200,000 annually, and 12 percent conducted business without a managed care contract (data not shown). Reference-group physicians received less of their income, on average, from Medicaid and managed care than from Medicare. Nearly two-thirds of them practiced in large metropolitan areas, and three-fourths of them perceived themselves to be working in a relatively competitive market.

Compared to the reference group, physicians with 50 percent or more Latino patients were more likely to be female and Latino, educated in non-US medical schools, and in certain specialties (pediatrics, other specialties, and obstetrics-gynecology); to work in a solo or two-physician practice, a health maintenance organization, or nonspecified (“other”) type of practice; to report a higher share of income from Medicaid and managed care; to work in large metropolitan areas with more than one million people; and to perceive no competition or some competition in the area where they work. Similarly, they were less likely to be board certified, to own the practice where they worked, and to treat patients with chronic conditions.

The report concluded that some of the problems behind the disparity could be alleviated by provisions in last year's Affordable Care Act, which is being legally challenged and could be decided on by the U.S. Supreme Court.