Educational Attainment and Satisfaction With the Healthcare System: Racial Variation

Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. Objectives: We tested ethnic differences in the association between education level and satisfaction with healthcare among American adults. Methods: The National Health Interview Survey (NHIS) included 24,835 adults who were Latino, non-Latino, African American, or White. The independent variable was education level. The dependent variable was satisfaction with healthcare. Logistic regression was used for data analysis. Results: For Whites, higher education levels were associated with greater healthcare satisfaction, as high school graduates (OR = 1.24; 95% CI = 1.02-1.52; P = 0.034) and college graduates (OR = 1.25; 95% CI = 1.02-1.53; P = 0.029) showed greater healthcare satisfaction than those with less than a high school diploma. African Americans, none of these education levels were associated with greater healthcare satisfaction. In the pooled sample, African American ethnicity showed significant statistical interactions with education level suggesting significantly smaller effects of high educational attainment on satisfaction with healthcare for African Americans than White adults (0.61; 95% CI = 0.38-1.00; P = 0.050 for AA x High School Graduate and o‎r = 0.60; 95% CI = 0.37-0.97; P = 0.036 for AA x Some College). Conclusion: High education level is associated with greater healthcare satisfaction for Whites but not African Americans. The healthcare system may undervalue people’s class when the patient is African American.