A Quantitative Analysis of Racial/Ethnic Disparities in Health Care Usage: The Roles of Perceptions of Care and Expected Longevity

Countless studies have documented the existence of disparities by race and ethnicity in the health care system in the United States. However, not many have sought to explicitly quantify the relative importance of each of the proposed determining factors. This dissertation thus sought to identify the major causes of disparities in health care usage by employing an adaptation of the Blinder/Oaxaca decomposition method originally used in the literature on wage differentials.;Specifically, this study sought to investigate the roles that racial differences in patients' perceptions of care and expected longevity (as they relate to expected gains) might play in the observed disparities in usage. Perceptions of care measures (trust and fear/dislike) were used to investigate the importance of the doctor-patient relationship in determining usage disparities through its effect on expected gains. Expected longevity was used as the length of time that someone expects to live would affect how willing they are to invest in anything with payoffs derived in the future. Thus, if expected net payoffs/gains of utilizing health care are positive, the individual would use care.;Results show that while expected longevity was found to positively affect whether or not someone utilizes care, it was not a contributing factor to the racial divide in usage. However, when exploring the role of perceptions of care, while the differences in utilization rates between whites and minorities were due mainly to unobserved factors peculiar to each racial/ethnic group, perceptions of care disparities also played a major role in addition to socioeconomic and access factors. These results, while encouraging the need for further analysis into what drives usage disparities by race, point out that the doctor-patient relationship (apart from SES and access issues) should also be considered as a possible contributor to racial/ethnic disparities in usage.