Frequency of interpersonal discrimination experiences - differences between inpatient and outpatient care and associations with delayed and forgone care.

Background: While the number of studies investigating the magnitude, reasons, and possible consequences of perceived discrimination in health care is growing, many of these studies do not differentiate between structural and interpersonal discrimination in health care. The latter rests upon stereotypes and takes place in direct interactions between the health care provider and the patient. In this study, we explore the frequency and main reasons of different interpersonal discrimination experiences in inpatient and outpatient care in Germany and associations of discrimination with delayed and forgone care.

Methods: Analyses were based on an online survey among the adult population in Germany (N = 3,246). A modified version of the Everyday Discrimination Scale was used to assess interpersonal discrimination experiences in inpatient and outpatient care. For each of the experiences, the main reason(s) for discrimination was ascertained. Indicators of delayed and forgone care referred to necessary doctor visits in the last 12 months.

Results: Analyses revealed that two thirds (66%) of the respondents reported at least one of five experiences in inpatient or outpatient care. The experience that people in health care acted as if they were better than oneself was reported most frequently (41.3% in outpatient care and 27.7% in inpatient care). All discrimination experiences were significantly more frequent in outpatient care than in inpatient care. Age and health insurance were the most frequently reported reasons for the discrimination experiences. There was a significant association of the frequency of interpersonal discrimination experiences with delayed and forgone care.

Conclusions: Experiences of interpersonal discrimination in health care were a frequent phenomenon in Germany and were significantly associated with unmet need. Such experiences must be considered an important issue for public health. Possible interventions to tackle discrimination include measures to reduce stereotypes and the abolition of the dual structure of statutory and private health insurance.