Does Diversity Matter for Health? Experimental Evidence from Oakland
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 of the same race. The effects are most pronounced for men who mistrust the medical system and for those who experienced greater hassle costs associated with their visit. 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 more consistent with better patient-doctor communication during the encounter rather than the differential quality of doctors or discrimination. our finding suggests 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.
Marcella Alsan, MD, MPH, PhD
Associate Professor of Medicine and Core Faculty Member at the Center for Health Policy and Primary Care and Outcomes Research, Stanford University
Marcella Alsan, MD, MPH, PhD, is an Associate Professor of Medicine at the Stanford School of Medicine and a Core Faculty Member at the Center for Health Policy / Primary Care and Outcomes Research. Alsan received a BA from Harvard University, a master’s in international public health from Harvard School of Public Health, a MD from Loyola University, and a PhD in Economics from Harvard University. Alsan trained at Brigham and Women’s Hospital - in the Hiatt Global Health Equity Residency Fellowship - then combined the PhD with an Infectious Disease Fellowship at Massachusetts General Hospital. Alsan attends in infectious disease at the Veterans Affairs Hospital.