Concordance and Patient-Centered Care in Medicaid Enrollees' Care Experience With Providers

Abstract

Patient-centered care is at the nexus of several overlapping institutional reforms to improve health care system performance. However, we know little regarding Medicaid patients' experience with their doctors along several key dimensions of patient-centered care, and how their experience compares with Medicare and privately insured patients. We studied 4 outcomes using the 2017 National Health Interview Survey: patient-provider concordance on racial/sexual/cultural identity, respectful provider attitude, solicitation of patient opinion/beliefs during the care encounter, and patient-centered communication (PCC). The primary independent variable was Medicaid enrollee status. We dichotomized responses and ran multivariate logistic regressions for each type of care experience outcome, controlling for sociodemographic factors, health care access, and health care utilization of respondents. Compared to Medicare and privately insured enrollees, Medicaid enrollees reported much lower odds of seeing providers who treated them with respect (OR = 1.91, P < .001; OR = 1.62, P < .01) and who offered PCC (OR = 1.35, P < .05; OR = 1.35, P < .01), but similar odds of seeing concordant providers (OR = 0.78, P = .96; OR = 0.96, P = .72). Importantly, Medicaid enrollees reported higher odds of seeing providers who solicited their opinion/beliefs/preferences than their Medicare or privately insured counterparts (OR = 0.82, P < .05; OR = 0.87 P < .10). Medicaid enrollees report less patient-centered experiences in some important facets of their provider interaction than their Medicare or privately insured counterparts. Federal, state, and local policies and practices directed at improving these facets of patient-provider interaction are needed and should be aimed squarely at Medicaid providers, especially those working in geographic areas and settings with a disproportionate number of racial, gender, cultural, and linguistic minorities.

Keywords: Medicaid enrollees; access to care; clinician–patient relationship; cultural competence; patient-centered communication; patient–provider concordance; payer status; shared decision-making.