Working Paper: NBER ID: w30767
Authors: Michael D. Frakes; Jonathan Gruber
Abstract: 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.
Keywords: No keywords provided
JEL Codes: I12; I14; J14
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Racial concordance between patients and providers (J15) | Improved maintenance of preventive care (I19) |
| One-standard deviation increase in the share of black providers (I24) | 15% relative decline in black mortality among patients with manageable illnesses (I14) |
| Improved medication use and adherence (I18) | 55-69% of the mortality impact (I12) |
| One-standard deviation increase in the share of black physicians (I14) | 4-day increase in metformin fill days (C41) |
| One-standard deviation increase in the share of black physicians (I14) | 58% increase in annual receipt of comprehensive diabetes care for black patients relative to non-black patients (I14) |
| Increased preventive care (I18) | 3% decline in mortality (I14) |