Table 1

Potential causes of ethnic differences in self-rated experience of healthcare, and associated policy implications

Potential causePotential policy implication
1. Ethnic minority patients are concentrated in poorly performing practices
  • Ethnic minority patients receive care from healthcare provider organisations whose performance is lower than average.

  • For example, most ethnic minority patients are enrolled with urban healthcare providers,16 and urban practices tend to have lower than average patient experience scores.8 17

Efforts to reduce variation in the performance of different provider organisations will also result in reduction of ethnic group inequalities.18
2. Ethnic minority patients get same care but report worse experience
  • Socio-cultural factors associated with ethnicity mean that patients of some ethnic groups score their experience systematically lower than patients of other ethnic groups even though their care is similar. This may occur for two reasons.

  • First, some minority ethnic group patients may have higher than average expectations of quality.5

  • Second, survey questions may be understood differently by patients of different ethnic (and/or linguistic) groups, resulting in variations in measured patient experience.19 This may be more likely when general as opposed to specific/report or composite experience measures are used.20

  • Socio-cultural factors associated with ethnic minority identity are outside the strict control of the healthcare system.

  • However, different socio-cultural norms need to be better understood, as such understanding could inform service provision, increase the ‘cultural competency’ of the healthcare system,21 and enhance service quality for ethnic minority patients.

  • Differences in response tendency could be accommodated by avoiding measures that are particularly sensitive to socio-demographic differences in scale use, and/or development of adjustment methods for these differences.19

3. Ethnic minority patients get worse care
Worse care is provided to ethnic minority patients compared with other patients in the same practice. This may be the result of different factors, including communication or access barriers (eg, because of imperfect comprehension of spoken or written language),7 or discrimination, unintended or otherwise.If applicable, removing barriers to communication or access (eg, increase of consultation time, availability of interpreters,22 or patient information leaflets in different languages) could improve the experience of ethnic minority patients.