Photo by Matthias Mueller, Flickr CC

Screening Therapy Clients by Race and Class

Black people, regardless of their insurance status, have more difficulty accessing health care than White people, and people with lower incomes receive less care than those with higher incomes. To further evaluate these care differences in access to mental health care, Heather Kugelmass undertook an audit study, now published in the Journal of Health and Social Behavior.

Using voice actors to portray middle-class White clients, middle-class Black clients, working-class White clients, and working-class Black clients, Kugelmass’s research team called 360 mental health care providers in New York City to leave messages requesting new patient appointments. The messages described the same symptoms and insurance, and they all requested weekday evening appointments. The recordings varied in name, vocabulary, and dialect, to portray both race and class (separate survey respondents who heard the recordings independently validated these portrayals by identifying the race and class of the speakers).

Callbacks were classified by whether the provider offered an appointment and whether the appointment offered was during the preferred time. Middle-class White callers received an appointment 28% of the time, compared with 17% of middle-class Black callers. Callers portraying working-class patients received appointment offers just 8% of the time, regardless of race. These differences were nearly mirrored in the breakdown of patients offered appointments at their preferred time, though women were offered their preferred time more often than men. Overall, a working-class Black man received just one evening appointment offer in 80 calls, while a middle-class White woman with the same insurance received 16.

One implication of these results is that those least likely to have paid sick time or flexible schedules—working-class patients—were least likely to be offered an appointment after work hours. Class biases among providers add to the care barrier for already underserved populations.

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