Introduction health economics has risen to the limelight.


The study and
relevance of health economics has majorly grown over the years. Due to the important developments in
the field of science, with respect to developing technology, health economics
has risen to the limelight. The World Health organisation (WHO) states health
economics is concerned with the connection between health and the resources
needed to promote it. Resources here just do not involve money but also people,
materials, time, which could have otherwise been used in different ways. (WHO
website). While authors like (Morrisey and Cawley 2008) state health economics
is defined by who health economists are and what they do. They examined the
field of Health economics and those that shape the discipline.

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The Book the economics of Health and health
care (Folland et al. 2016) captures the relevance of health economic. They
capture the national policy concerns resulting from people concerns in the
economic problems faced by them while maintaining their health and how many of
these health issues have a substantial economic problem. While there are so
many ways of analysing the economical aspect of health and so many elements and
divisions of health and health care sector, the paper focuses on mainly the
cultural background, also covering race and ethnicity of a doctor in the
medical field. Every human being in this world is prone to certain diseases,
health issues and thus the need to visit a doctor to cure his or her ailment is
a must, even if it incurs expenses, as without good health, we cannot survive
in the long run.

The criteria by which patients really choose
their doctors is still something which needs to be studied in detail. There are
many definitions of race, some which specifically state ‘race’, denotes a, ‘a
more or less distinct group by genetically transmitted physical characteristics’
(American Heritage Dictionary) Similarly, the word ‘ethnicity´, is defined as
‘pertaining to a social group within a cultural social system that claims or is
accorded special status on the basis on complex, traits including religious,
ancestral or physical characteristics’ (American Heritage Dictionary of English
Language). While there are many studies of cross cultural physician – patient
relationships, there are also specific proofs of racial differences in The
United States of America with white patients who seem to get better treatments
from their doctors then compared to minority or Black community. The belief
that a community will be more comfortable in consulting doctors of their own
community is something which still needs to be backed by empirical results and
understanding. The country of origin of the doctors has an
influence on students` choice if they need to visit a doctor

paper focuses on the research question, ‘The
country of origin of the doctors has an influence on students` choice if they
need to visit a doctor’. The experiment is centered around three
communities namely the German community, Polish community and the Indian
Community. The aim is to see how does origin of a doctors (his ethnicity,
community or cultural competence) really influences the patient’s choice, here
being ‘students’ in selecting a doctor. The notion that a student may prefer a
doctor from his or her own community holds true except, this might not be
entirely true. The psychology of the mind works in different ways. There can be
circumstances where there is no option but to just perform the operation with
the best doctor in the field and hence does origin, really matter in that case?
All this will be further explained as we move further in this research paper.





what basis do patients really choose their doctors is still debatable, the fact
that it could be based on the origin, the race or ethnicity cannot be ruled
out. Cultural competence of a doctor can also be the reason why a patient wants
to be consulted by him or her. The American Medical Association (AMA) has its
own Cultural Competence Compendium, in which it defines culture as ‘any group
of people who share experience, languages and values that permit them to
communicate knowledge not shared by those outside the culture.’ The AMA also
states that ‘Culturally competent physicians are able to provide patient
centred care by adjusting their attitudes and behaviours to account for the
impact of emotional, cultural, social, and psychological issues on the ailment’
(American Medical Association) Hence, it is notable that given a doctor’s
background or history the patient might make a better rapport with him and the
doctor may also be more supportive in making the patient feel more comfortable.

America racial discrimination has a history. Efforts to increase the different
ethnicity of doctors have been a focus, whether it is the African American
doctors or the Hispanic doctors (Thomas and Amani 2002) The underlying fact
being the minority will be represented by them or through them. With the
constant efforts, Medical schools have responded to the proposition by
increasing the production of minority doctors pass outs. (Carlisle et al. 1998;
Libby et al. 1997). (Cooper- Patrick et al. 1999) in their research study
conducted a telephonic survey, of 1816 African Americans and white adults, the
patients selected were those which recently took part in the care practice and
they were taken to analyse and assess the doctor patient decision making
participatory style. The results showed patients who are give more importance
to race have rated their physicians more participatory than compared to
patients who are not such big believers of race

similar area of inquiry where, patients believe that race play an important
role can be seen in the experiment conducted were patients choose their
healthcare providers according to race. 
National Medical Expenditure Survey conducted by (Gray and Stoddard
1997) concluded the fact that patients from minority community choose doctors
belonging to that minority community.(Saha et al. 2000) further demonstrated
that Black, White and Hispanic choose doctors of their own race because of
their own personal preference and comfort and not just because they were
limited doctors in that field. The theory that minority of doctors will
practice in their own minority communities has also been well documented (Moy
and Bartman 1995)

et al. 1999) also found that African American race concordant people are more
like to rate their physicians as the best or excellent rated. While there are
some researchers like (Chen et al. 2001) who were not able to find any race or
cultural differentiation in the field cardiac catheterization. (Litt and Cuskey
1998) focused on the satisfaction aspect of meeting a doctor. Their studies
showed adolescents who reported higher satisfaction after an                                                                                                                  
          initial visit with the doctor are more likely
to go back to the doctor for a follow up appointment as compared to an
unsatisfied patient in the first visit. Subsequent studies have also showed
that patient satisfaction and appointment keeping have showed the same results
confirming this theory and relationship (Fred et al. 1998, Carlson and Gabriel
2001, Ivanov and Flynn 1999) While patients may choose physicians from their
own race the outcome of the service provided and how successful is it, is still
something which needs more research.




the empirical studies show a direct effect on the doctors and patients race
concordance on patient outcomes is limited, the patient’s satisfaction on health-related
outcomes do also have an impact. As stated by (Scanlon et al. 2001;
Harris-Kojetin et al. 2001; Cleary and McNeil 1988; Mukamel and Mushlin 2001;
Simon and Monroe 2001) in the surveys of healthcare quality assessments and
health care system performance, patient satisfaction is widely considered and a
key competence. Individual healthcare customers and employees use satisfaction
ratings as an aid to choose health care plans and providers (Crofton, Lubalin,
and Darby 1999).

 Intercultural communication between the
patient and the doctor influences the satisfaction level of the patients.
According to a survey by (The Department of General Practice, Erasmus
University, Rotterdam, The Netherlands) there have been problems in communication
between the health care workers and ethnic- minority people which leads to
incorrect diagnoses, non-compliance with the treatment and thus not proper use
of health services. They also state that although there is not more known cause
of communication problems, but it is always not the language problem, but its
also the cultural difference on how people think about the health, disease and
health care. The health beliefs of the western physicians are normally shaped
by their own cultural background and their biomedical and training but the health
beliefs of people of other cultures are not similar with those of the Western health
care workers and hence the risk of misunderstanding arises.

there are so many diseases which can affect a human body, the research paper
focuses on common cold as the reason of going to the doctor. The common cold or
influenza (flu) is one of the most common disease in the world. In the book,
The Lancet Infectious Diseases, the author (Eccles 2005) states that the common
cold is the most common infection affecting the human being. This disease
mainly being based on symptomatology, however the ability to understand all the
symptoms is still poor for a common man, then compared to a doctor having a
look at them. (Eccles 2005) all mentions that with so many viruses in the air,
when a simple cold can transform into something more dangerous, is not known.
Hence common cold should be treated with care. The hypothesis, The country of
origin of the doctors has an influence on students choice of the doctor will
now be examined in this paper.



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Department of Health Policy and Management,
Erasmus University, Rotterdam, The Netherlands.