Racial Concordance and the Quality of Medical Care: Evidence from the Military
One explanation for insufficient use of primary care in the U.S. is a lack of trust between patients and providers – particularly along racial lines. We assess the role of racial concordance between patients and medical providers in driving use of preventive care and the implications for patient outcomes. We use unique data from the Military Health System, where we observe providers as patients so that we can identify their race, and where moves across bases change exposure to provider race. We consider patients with four chronic, deadly, but ultimately manageable illnesses, where the relationship with the provider may have the most direct and important impact on health. We find striking evidence that racial concordance leads to improved maintenance of preventive care – and ultimately lower patient mortality. Pooling across these diseases, we estimate that a one-standard deviation increase in the share of providers who are Black leads to a 15% relative decline in Black mortality among those with these manageable illnesses. Our results further suggest that between 55 and 69% of this mortality impact arises through improved medication use and adherence, with other aspects of the provider-patient relationship accounting for the residual.
We are grateful to Sadie Emch for excellent research assistance. We are also grateful to Marcella Alsan, Bapu Jena, and seminar participants at the NBER Summer Institute (Health Care Meeting), the Duke Law School Faculty Workshop, and the University of Alabama School of Law workshop for helpful comments. We acknowledge funding from NIA grant R01AG049898. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
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