racial access disparities; racial health disparities; racial identity; healthcare utilization


Purpose: Studies have suggested that even when minority groups have potential access to healthcare, they may have inadequate utilization (realized access). This study explores the application of a theory from the social psychology and political science literatures concerning how racial centrality and racial realities, specifically amongst Blacks, may influence patients’ healthcare utilization preferences.

Methods: We created a survey with two (pseudo) randomized, controlled experimental treatments designed to assess whether racialized hospital and physician characteristics elicited a preference from Black or White respondents, as well as questions aimed at understanding participants’ different beliefs and levels of knowledge about past and current racial health disparities. The survey was distributed online by Qualtrics to paid Black (n=225) and White (n=75) participants. Data were analyzed using bivariable statistics.

Results: Black respondents preferred a hospital with an advertisement featuring Black healthcare workers (p<.01), an association that was correlated with higher levels of Black centrality (p<.01), beliefs that the Tuskegee Syphilis Experiment could happen today (p<.05), and a lack of trust in the healthcare system (p<.01). No such association was observed for White respondents. Neither White nor Black respondents showed any significant associations concerning preference for a physician with a racialized name. Blacks respondents were significantly more likely to answer questions concerning the existence of health disparities correctly; however, there was no difference in the number of healthcare-related discriminatory experiences or general trust of healthcare organizations observed between respondents of the two races.

Conclusions: Black subjects appeared to prefer health institutions that give the outward appearance of being diverse. This choice was associated with racial group centrality and knowledge of certain racial realities. As more equal access is legislated, the role racial identity plays in affecting utilization patterns should be better understood in order to inform future health care programs and policies.