Racial/Ethnic Disparities In Mental Health Service and Medical Care Expenditures

Jones, Audrey

Abstract

Compared to Non-Latino White Americans, Black and Latino populations often receive health services of lower intensity or quality. This is particularl true in the area of mental health. Black and Latino populations are often less likely than Non-Latino Whites to receive timely and accurate mental health diagnoses, and less likely than Whites to receive evidence-based treatments for mental health conditions. Despite these large gaps, there is a lack of consensus whether disparities in mental health expenditures are primarily due to differences in access to care or whether there are also disparities in the quality or intensity of mental health services (MHS) among those with access. Identifying the point at which disparities occur in the delivery of MHS is critical to the development of targeted interventions to improve the quality of mental health services, particularly for underserved minority populations. The overall objective of this study is to answer questions of inequity in the delivery of MHS among racial/ethnic minority populations at-risk for mental illness. The project aims are: 1) to resolve the question of whether racial/ethnic differences in mental health expenditures are due to differences in access to care or whether there are also differences in the intensity of services provided;2) to determine if the known racial/ethnic disparity in MHS is even greater among those with greater mental health needs;and 3) To determine if the hypothesized interaction between race/ethnicity and mental health needs (Aim 2) extends to similar disadvantages in use of medical care. To meet the study objectives, this study proposes to use longitudinal data from the National Health Interview Survey and the linked two-year Medical Expenditures Panel Survey. My approach uses a validated screening measure of psychological distress in both the NHIS and MEPS to identify individuals varying in need for mental health services. The outcomes of interest (outpatient mental health expenditures;overall medical care expenditures) are identified prospectively from the MEPS. The analytic approach employs multivariate two-part models (logit, GLM) to estimate racial/ethnic disparities in the probability of service use and in the average service expenditures among adults varying in need for mental health services. Study findings will help to resolve questions of the origin of racial/ethnic disparities in MHS. By estimating service expenditures across populations varying in need, this research will determine if the healthcare system is less responsive to the increased mental health needs of racial/ethnic minority populations. Study findings may identify particular sub- populations disadvantaged by the healthcare system that may benefit from initiatives to improve the quality of MHS, particularly in the primary care setting. In the face of health reform, this research will offer guidance to ensure equitable resource allocation for Black and Latino populations that is needed to improve the health and well-being of the nation.

Public Health Relevance

The proposed research will provide improved understandings of inequalities in the distribution of mental health and medical care resources among racial/ethnic minorities who have an elevated risk-for mental illness. As large numbers of Black and Latino minorities are likely to gain access to insurance through the Affordable Care Act, study findings will be useful for guiding the development of policies to improve access to and quality of mental health services for vulnerable and underserved populations. By bringing attention to medical and mental health service expenditures, study findings may inform healthcare initiatives which aim to improve the integration of mental health services in medical care, particularly for racial/ethnic minorities.