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Does diversity matter for health? Experimental evidence from Oakland

Sep 2018
Working Paper
18-030
By  Marcella Alsan, Owen Garrick, Grant Graziani

We study the effect of diversity in the physician workforce on the demand for preventive care among African-American men. Black men have the lowest life expectancy of any major demographic group in the U.S., and much of the disadvantage is due to chronic diseases, which are amenable to primary and secondary prevention. In a field experiment in Oakland, California, we randomize black men to black or non-black male medical doctors and to incentives for one of the five offered preventives the flu vaccine. We use a two-stage design, measuring decisions about cardiovascular screening and the flu vaccine before (ex ante) and after (ex post) meeting their assigned doctor. Black men select a similar number of preventives in the ex ante stage, but are much more likely to select every preventive service, particularly invasive services, once meeting with a doctor who is the same race. The effects are most pronounced for men who have little experience obtaining routine medical care and among those who mistrust the medical system. Subjects are more likely to talk with a black doctor about their health problems and black doctors are more likely to write additional notes about the subjects. The results are most consistent with better patient-doctor communication during the encounter rather than discrimination or measures of doctor quality and eort. Our ndings suggest black doctors could help reduce cardiovascular mortality by 16 deaths per 100,000 per year leading to a 19% reduction in the black-white male gap in cardiovascular mortality.

Publication Keywords: 
homophily
concordance
Communication
behavioral misperceptions