The study and relevance of health economics have majorly grown over the years. Due to the important developments in the field of science, with respect to developing technology, health economics has risen to the limelight. The World Health Organization (WHO) states health economics is concerned with the connection between health and the resources needed to promote it. Resources here just do not involve money but also people, materials, time, which could have otherwise been used in diverse ways. (WHO website). While authors like (Morrisey and Cawley 2008) state health economics is defined by who health economists are and what they do. They examined the field of Health economics and those that shape the discipline.
The book ‘The Economics of Health and Healthcare (Folland et al. 2016) captures the relevance of health economics. They capture the national policy concerns resulting from people concerns in the economic problems faced by them while maintaining their health and how many of these health issues have a substantial economic problem. While there are so many ways of analyzing the economic aspect of health and so many elements and divisions of health and health care sector, the paper focuses on mainly the cultural background, also covering race and ethnicity of a doctor in the medical field. Every human being in this world is prone to certain diseases, health issues and thus the need to visit a doctor to cure his or her ailment is a must, even if it incurs expenses as, without good health, we cannot survive in the long run.
The criteria by which patients really choose their doctors is still something which needs to be studied in detail. There are many definitions of race, some which specifically state ‘race’, denotes a, ‘a more or less distinct group by genetically transmitted physical characteristics’ (American Heritage Dictionary) Similarly, the word ‘ethnicity´, is defined as ‘pertaining to a social group within a cultural social system that claims or is accorded special status on the basis of complex, traits including religious, ancestral or physical characteristics’ (American Heritage Dictionary of English Language). While there are many studies of cross-cultural physician-patient relationships, there are also specific proofs of racial differences in The United States of America with white patients who seem to get better treatments from their doctors then compared to minority or Black community. The belief that a community will be more comfortable in consulting doctors of their own community is something which still needs to be backed by empirical results and understanding. The country of origin of the doctors has an influence on students` choice if they need to visit a doctor
This paper focuses on the research question, ‘The country of origin of the doctors has an influence on students` choice if they need to visit a doctor’. The experiment is centered around three communities namely the German community, Polish community and the Indian Community. The aim is to see how does the origin of doctors (his ethnicity, community or cultural competence) really influences the patient’s choice, here being ‘students’ in selecting a doctor. The notion that a student may prefer a doctor from his or her own community holds true except, this might not be entirely true. The psychology of the mind works in different ways. There can be circumstances where there is no option but to just perform the operation with the best doctor in the field and hence does the origin, really matter in that case? All this will be further explained as we move further in this research paper.
On what basis do patients really choose their doctors are still debatable, the fact that it could be based on the origin, the race or ethnicity cannot be ruled out. Cultural competence of a doctor can also be the reason why a patient wants to be consulted by him or her. The American Medical Association (AMA) has its own Cultural Competence Compendium, in which it defines culture as ‘any group of people who share experience, languages, and values that permit them to communicate knowledge not shared by those outside the culture.’ The AMA also states that ‘Culturally competent physicians are able to provide patient centered care by adjusting their attitudes and behaviors to account for the impact of emotional, cultural, social, and psychological issues on the ailment’ (American Medical Association) Hence, it is notable that given a doctor’s background or history the patient might make a better rapport with him and the doctor may also be more supportive in making the patient feel more comfortable.
In America, racial discrimination has a history. Efforts to increase the different ethnicity of doctors have been a focus, whether it is the African American doctors or the Hispanic doctors (Thomas and Amani 2002) The underlying fact being the minority will be represented by them or through them. With the constant efforts, Medical schools have responded to the proposition by increasing the production of minority doctors pass outs. (Carlisle et al. 1998; Libby et al. 1997). (Cooper- Patrick et al. 1999) in their research study conducted a telephonic survey, of 1816 African Americans and white adults, the patients selected were those which recently took part in the care practice and they were taken to analyze and assess the doctor-patient decision making participatory style. The results showed patients who are given more importance to race have rated their physicians more participatory than compared to patients who are not such big believers of race
A similar area of inquiry where patients believe that race played a vital role can be seen in the experiment conducted was patients choose their healthcare providers according to race. National Medical Expenditure Survey conducted by (Gray and Stoddard 1997) concluded the fact that patients from minority community choose doctors belonging to that minority community. (Saha et al. 2000) further demonstrated that Black, White and Hispanic choose doctors of their own race because of their own personal preference and comfort and not just because they were limited doctors in that field. The theory that minority of doctors will practice in their own minority communities has also been well documented (Moy and Bartman 1995)
(Saha et al. 1999) also found that African American race-concordant people are more like to rate their physicians as the best or excellent rated. While there are some researchers like (Chen et al. 2001) who were not able to find any race or cultural differentiation in the field cardiac catheterization. (Litt and Cuskey 1998) focused on the satisfaction aspect of meeting a doctor. Their studies showed adolescents who reported higher satisfaction after an initial visit with the doctor are more likely to go back to the doctor for a follow-up appointment as compared to an unsatisfied patient in the first visit. Subsequent studies have also showed that patient satisfaction and appointment keeping have showed the same results confirming this theory and relationship (Fred et al. 1998, Carlson and Gabriel 2001, Ivanov and Flynn 1999) While patients may choose physicians from their own race the outcome of the service provided and how successful is it, is still something which needs more research.
Although the empirical studies show a direct effect on the doctors and patients race concordance on patient outcomes is limited, the patient’s satisfaction with health-related outcomes does also have an impact. As stated by (Scanlon et al. 2001; Harris-Kojetin et al. 2001; Cleary and McNeil 1988; Mukamel and Mushlin 2001; Simon and Monroe 2001) in the surveys of healthcare quality assessments and health care system performance, patient satisfaction is widely considered and a key competence. Individual healthcare customers and employees use satisfaction ratings as an aid to choose health care plans and providers (Crofton, Lubalin, and Darby 1999).
Intercultural communication between the patient and the doctor influences the satisfaction level of the patients. According to a survey by (The Department of General Practice, Erasmus University, Rotterdam, The Netherlands), there have been problems in communication between the healthcare workers and ethnic- minority people which leads to incorrect diagnoses, non-compliance with the treatment and thus not a proper use of health services. They also state that although there is not a more known cause of communication problems, it is always not the language problem, but its also the cultural difference on how people think about the health, disease and health care. The health beliefs of the western physicians are normally shaped by their own cultural background and their biomedical and training but the health beliefs of people of other cultures are not similar with those of the Western health care workers and hence the risk of misunderstanding arises.
While there are so many diseases which can affect a human body, the research paper focuses on common cold as the reason for going to the doctor. The common cold or influenza (flu) is one of the most common diseases in the world. In the book, The Lancet Infectious Diseases, the author (Eccles 2005) states that the common cold is the most common infection affecting the human being. This disease mainly being based on symptomatology, however, the ability to understand all the symptoms is still poor for a common man, when compared to a doctor having a look at them. (Eccles 2005) all mention that with so many viruses in the air when a simple cold can transform into something more dangerous, is not known. Hence common cold should be treated with care. The hypothesis, The country of origin of the doctors has an influence on students choice of the doctor will now be examined in this paper.
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Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.