Journal of General Internal Medicine

, Volume 19, Issue 2, pp 101–110

Racial and ethnic differences in patient perceptions of bias and cultural competence in health care

  • Rachel L. Johnson
  • Somnath Saha
  • Jose J. Arbelaez
  • Mary Catherine Beach
  • Lisa A. Cooper
Original Articles


OBJECTIVES: To determine: 1) whether racial and ethnic differences exist in patients’ perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables.

DESIGN: Cross-sectional telephone survey.

SETTING: The Commonwealth Fund 2001 Health Care Quality Survey.

SUBJECTS: A total of 6,299 white, African-American, Hispanic, and Asian adults.

MEASUREMENTS AND MAIN RESULTS: Interviews were conducted using random-digit dialing; oversampling respondents from communities with high racial/ethnic minority concentrations; and yielding a 54.3% response rate. Main outcomes address respondents’ perceptions of their PCPs’ and health care system-related bias and cultural competence; adjusted probabilities (Pr) are reported for each ethnic group. Most racial/ethnic differences in perceptions of PCP bias and cultural competence were explained by demographics, source of care, and patient-physician communication variables. In contrast, racial/ethnic differences in patient perceptions of health care system-wide bias and cultural competence persisted even after controlling for confounders: African Americans, Hispanics, and Asians remained more likely than whites (P<.001) to perceive that: 1) they would have received better medical care if they belonged to a different race/ethnic group (Pr 0.13, Pr 0.08, Pr 0.08, and Pr 0.01, respectively); and 2) medical staff judged them unfairly or treated them with disrespect based on race/ethnicity (Pr 0.06, Pr 0.04, Pr 0.06, and Pr 0.01, respectively) and how well they speak English (Pr 0.09, Pr 0.06, Pr 0.06, and Pr 0.03, respectively).

CONCLUSION: While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system.

Key words

bias cultural competence disparities racial and ethnic minorities 


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Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Rachel L. Johnson
    • 1
    • 2
  • Somnath Saha
    • 3
  • Jose J. Arbelaez
    • 1
    • 4
  • Mary Catherine Beach
    • 1
    • 2
    • 4
  • Lisa A. Cooper
    • 1
    • 2
    • 4
  1. 1.Received from Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityBaltimore
  2. 2.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimore
  3. 3.Section of General Internal Medicine, Portland VA Medical Center, and Department of MedicineOregon Health & Science UniversityPortland
  4. 4.Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimore

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