ity patients’ ratings of the quality of their health care were generally higher in racially and ethnically concordant than racially and ethnically discordant settings. Using a measure of physicians’ participatory decision-making style, Cooper-Patrick surveyed over 1,800 adults who were seen in 1 of 32 primary care settings by physicians who were either African American (25 percent of the physician sample), white (56 percent), Asian American, (15 percent), or Latino (3 percent). Overall, African American patients rated their visits as significantly less participatory than whites, after adjusting for patient age, gender, education, marital status, health status, and length of the patient–physician relationship. Patients in race- and ethnic-concordant relationships, however, rated their visits as significantly more participatory than patients in race- and ethnic-discordant relationships. In addition, Cooper and Roter have found, through independent ratings of videotaped clinical encounters, that physician visits by African American patients were longer, were characterized by less physician dominance of the discussion, and were more patient-centered when the physician was African American than when the physician was white (Cooper and Roter, 2003).

Similarly, LaVeist and Nuru-Jeter (2002) examined predictors of racial concordance between patient and clinician and the effect of race concordance on satisfaction among a sample of white, African American, and Hispanic patients. Among all racial and ethnic groups, patients who reported having at least some choice in selecting a physician were more likely to have a race- or ethnic-concordant physician. Having a race-concordant physician was also associated with higher income for African Americans and not speaking English as a primary language among Hispanics. After adjusting for patients’ age, sex, marital status, income, health insurance status, and whether the respondent reported having a choice in physician, African American patients in race-concordant relationships were found to report higher satisfaction than those African Americans in race-discordant relationships. Furthermore, Hispanic patients in ethnic-concordant relationships reported greater satisfaction than patients from other racial and ethnic groups in similarly concordant relationships.

Diversity and Quality of Health Care for Minority Populations

Racial and ethnic minorities tend to receive a lower quality of health care than nonminorities. Much of this disparity may be explained by the overrepresentation of some minority groups among the uninsured, given that uninsured and underinsured individuals face greater difficulties in accessing care and are less likely to receive needed services. Yet a large body of research demonstrates that even when insured at the same levels as whites, minority patients receive fewer clinical services and receive a lower



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