The goal of this proposal, responsive to RFA-MD-15-001 'System-Level Health Services and Policy Research on Health Disparities (R01)', is to examine whether recent policy changes that aim to improve utilization and quality of behavioral health care in the general population have had a positive impact on race/ethnic disparities in care. Although efficacious treatments for psychiatric disorders have become widely available, the allocation of treatment across the population remains inequitable. Race and ethnic disparities in mental health care, defined by a landmark Institute of Medicine report as differences in receipt of care not attributable to either health status or treatment preferences, have consistently been found both in utilization and quality of behavioral health care. Disparities in treatment of psychiatric and substance use disorders across race/ethnic minority populations are particularly concerning because of the adverse impact that these disorders have across the adult life course, including effects on exposure to violence, family formation, educational attainment, employment, income and mortality. Barriers to treatment faced by members of race/ethnic minority populations can compound pre-existing social disadvantages and contribute to the persistence of broader social inequalities. This project examines four recent state and federal policy initiatives: 1) the requirement that young adults be eligible to remain on their parent or guardian's health insurance policy through age 26, 2) the expansion of Medicaid eligibility to those with incomes up to 138% of the Federal Poverty Line, 3) expansion of managed care, and 4) mental health parity. While each of these policies has beneficial impacts at a population level, their impacts on disparities in care have not been examined. This is a critical gap in our knowledge because programs that improve utilization and quality of care in the general population can have neutral or even negative impacts on disparities. State-level variation in each of these policies, in some cases pre-dating federal legislation, provides an opportunity to assess their impact on disparities empirically. This project will first use the National Survey of Drug Use and Health, the nation's largest behavioral health surveillance survey to assess the impact of each of these policies and variation in policy impacts across geographic areas. We will then examine a set of complementary outcomes using the Medical Expenditure Panel Survey, which has a smaller sample size but additional detail on costs and quality of care, which are important for understanding equity in the behavioral health services. Empirical evaluation of the impacts of major recent health policy initiatives is needed to guide future policy strategies towards more effective reduction of disparities in behavioral health care and reducing the disproportionate burden of mental and substance use disorders on race and ethnic minorities in the US.

Public Health Relevance

Although efficacious treatments for psychiatric and substance use disorders have become widely available, the allocation of treatment across the population remains inequitable. The goal of this proposal, responsive to RFA-MD-15-001 'System-Level Health Services and Policy Research on Health Disparities (R01)', is to examine whether recent policy changes that aim to improve utilization and quality of behavioral health care in the general population have had a positive impact on race/ethnic disparities. Empirical evaluation of policy impacts is needed to guide future policy strategies towards more effective reduction of disparities in behavioral health care and reducing the disproportionate burden of mental and substance use disorders on race and ethnic minorities in the US.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Research Project (R01)
Project #
5R01MD010274-05
Application #
9614806
Study Section
Special Emphasis Panel (ZMD1)
Program Officer
Alvidrez, Jennifer L
Project Start
2015-06-24
Project End
2020-12-31
Budget Start
2019-01-01
Budget End
2020-12-31
Support Year
5
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
006914071
City
Santa Monica
State
CA
Country
United States
Zip Code
90401
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Breslau, J; Wong, E C; Burnam, M A et al. (2018) Associations of Perceived Discrimination With Impaired Functioning in a Population Sample With Psychological Distress. Psychiatry 81:130-140
Breslau, Joshua; Stein, Bradley D; Han, Bing et al. (2018) Impact of the Affordable Care Act's Dependent Coverage Expansion on the Health Care and Health Status of Young Adults: What Do We Know So Far? Med Care Res Rev 75:131-152
Breslau, Joshua; Han, Bing; Stein, Bradley D et al. (2018) Did the Affordable Care Act's Dependent Coverage Expansion Affect Race/Ethnic Disparities in Health Insurance Coverage? Health Serv Res 53:1286-1298
Breslau, Joshua; Stein, Bradley D; Yu, Hao et al. (2018) Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care. Adm Policy Ment Health :
Breslau, Joshua; Cefalu, Matthew; Wong, Eunice C et al. (2017) Racial/ethnic differences in perception of need for mental health treatment in a US national sample. Soc Psychiatry Psychiatr Epidemiol 52:929-937
Breslau, J; Gilman, S E; Stein, B D et al. (2017) Sex differences in recent first-onset depression in an epidemiological sample of adolescents. Transl Psychiatry 7:e1139
Breslau, Joshua; Yu, Hao; Han, Bing et al. (2017) Did the dependent coverage expansion increase risky substance use among young adults? Drug Alcohol Depend 178:556-561