Are African Americans Really Less Willing to Use Health Care?

Abstract

Racial and ethnic disparities in medical treatment are usually held to reflect an implicit physician bias and/or patient predispositions and expectations. Although evidence favoring either side has been slim, predispositions have played an increasingly prominent role in the debate. Indeed, even opposing sides seem to take for granted that African Americans are more averse to using health care and more skeptical of its effectiveness. In this article, black-white differences in treatment predispositions and expectations are explored for a variety of hypothetical symptoms and treatment outcomes. Using data from the 2000 General Social Survey, we find no evidence that African Americans are less likely to seek treatment or that they expect less from treatment. If anything, African Americans report greater willingness to seek treatment for some symptoms and greater optimism regarding some treatment outcomes. These black-white differences are affected little by education or income. The results are at odds with much previous speculation and are discussed in light of research that suggests that African Americans do seek care less often and refuse treatments at higher rates, and evidence that shows African Americans are less satisfied with their physician visits. By suggesting a disjuncture between African Americans' expectations for care and the reality of the care they receive, the results point to the social process that transforms predispositions and produces disparities. Results suggest several important considerations for future research, including the dynamics of doctor-patient interaction.