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Type of Document Dissertation Author Cleeland, Robin Naugher URN etd-03212006-230411 Title Understanding Disparities in Health Care: Non-Medical Factors Influencing Physicians' Clinical Decision-Making for the Uninsured Degree Doctor of Philosophy Department Social Work, College of Advisory Committee
Advisor Name Title C. Aaron McNeece Committee Chair Mary Ellen Guy Committee Member Wendy P. Crook Committee Member Keywords
- Inequality
- Access
- Medical Care
- Social Work
- Public Health
- Health
- Indigent
- Health Insurance
- Decisions
- Physicians
- Prejudice
- Stereotypes
- Health Policy
- Health Care Administration
- Medical Sociology
- Disparities In Health Care
- Equity
- Race
- Ethnicity
- Family Physicians
- Georgia
Date of Defense 2006-03-14 Availability unrestricted Abstract Lack of health insurance is a significant public health concern in the U.S. Currently more than 45 million Americans do not have any health insurance, and many more are underinsured. Public policy approaches that seek to improve access to medical care for the uninsured and underinsured must be based on an understanding of physician decision-making because physicians are gatekeepers who play an important role in determining the quantity and quality of medical care.
This dissertation explores the relationship between physician variables (job satisfaction, decision-making style, social distance and length of time in practice), patient variables (insurance status, race, and ethnicity) and treatment recommendations by physicians for insured and uninsured patients. Survey instruments measuring social distance, job satisfaction, and tacit decision-making were mailed to a random sample of 250 Georgia family physicians. Decision outcomes were measured through the use of four vignettes that depict common, hypothetical scenarios requiring clinical decision-making. The vignettes varied only in the depiction of the patients described as in terms of insurance status, race, and ethnicity.
The data indicated that in three of four hypothetical scenarios, physicians' clinical decisions varied depending on combinations of patient characteristics. The data also revealed that lack of health insurance (but not African American race or Latino ethnicity) resulted in lower decision outcome scores. No relationship was found between the set of physician variables (job satisfaction, decision-making style, social distance, and time in practice) and decision outcome scores. Decision-making style was negatively associated with decision outcome in Scenario 1. Time in practice was positively associated with decision outcome in Scenario 2. Time in practice was positively associated with job satisfaction. This study has important implications for health care policy in developing an effective response to the problem of medical indigence.
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