Can Medicaid Benefits Reduce Access Disparities for Minority Children & Youth?

描述（由申请人提供）：本研究的目的是检查医疗补助计划（Medi-Cal）早期定期筛查诊断和治疗计划（EPSDT）的积极执行情况，以了解是否通过提供慷慨的资金，增加治疗能力，参与以社区为基础的项目和组织将带来预期的政策效果，使低收入白人和少数民族儿童和青少年的支出和治疗模式均衡。研究目的是：1)估计加州EPSDT心理健康项目的扩展在多大程度上减少了非裔美国人、拉丁裔美国人和印第安人在加州医疗保险注册儿童和青少年方面的支出差距。确定支出差距的减少在多大程度上是立竿见影的，在多大程度上构成了少数族裔与白人的趋同趋势。2)估计加州实施EPSDT心理健康服务在多大程度上减少了非裔美国人、拉丁裔美国人和土著美国人在加州医疗保险登记的儿童和青少年获得心理健康服务的差距（以总体渗透率、门诊治疗渗透率和危机治疗渗透率衡量）。确定有多少机会差距的减少是立竿见影的，有多少是少数族裔与白人趋同的趋势。3)对上述1和2中描述的每个依赖度量的估计，减少少数族裔与白人之间差异的程度与：a)总提供者供应和讲西班牙语的提供者供应的增加；b)增加与社区组织的接触，包括那些以少数民族为重点的组织。使用一种“中断时间序列”方法的面板数据多元回归方法（Shadish, Cook & Campbell, 2002），我们控制了与积极执行EPSDT相关的因素，这些因素可能会混淆我们对其对成本和获取差异的影响的评估。我们将在48个季度（1992年7月至2004年6月）和加州57个县的心理健康计划中观察EPSDT实施前后的成本和渗透率。由于我们的重点是少数民族和白人之间的差异随时间的变化，任何潜在的混杂因素必须对少数民族或白人产生不同的影响，从而影响研究结果。为了进一步检验假设，我们对比了受EPSDT执行影响最小和不受其影响的子样本的差异。将使用从加州心理健康部门获得的Medi-Cal专业心理健康索赔数据和Medi-Cal注册数据。

DESCRIPTION (provided by applicant): The study goal is to examine the aggressive enforcement of Medicaid's (Medi-Cal's) Early Periodic Screening Diagnosis and Treatment program (EPSDT) to learn whether reducing important structural barriers to public mental health care by providing generous financing, increasing treatment capacity, and engaging with community-based programs and organizations will bring about the desired policy effect of equalizing spending and treatment patterns among low-income white and ethnic minority children and youth. Study aims are: 1) Estimate the extent to which California's EPSDT mental health program expansion reduced disparities in spending for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in spending disparities was immediate and how much it constituted minority-white convergence in trends. 2) Estimate the extent to which California's enforcement of EPSDT mental health services reduced disparities in access (measured by overall penetration rates; outpatient treatment penetration rates; and crisis treatment penetration rates) for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in access disparities was immediate and how much it constituted minority-white convergence in trends. 3) Estimate for each dependent measure described in 1 and 2 above the extent to which reduced minority-white disparities was associated with: a) increases in total provider supply and Spanish-speaking provider supply; and b) increased engagement with community-based organizations including those with an ethnic minority focus. Using panel data multivariate regression methods in a kind of "interrupted time-series" approach (Shadish, Cook & Campbell, 2002), we control for factors correlated with aggressive EPSDT enforcement that could confound our assessment of its impact on cost and access disparities. We will observe costs and penetration rates before and after EPSDT enforcement over 48 quarters (July 1992 - June 2004) and across the 57 California county mental health plans. Since our focus is on changes in disparities between ethnic minorities and whites over time, any potential confounds must differentially affect ethnic minorities or whites to influence study results. To further test hypotheses, we contrast disparities in sub-samples minimally affected by, and unaffected by, EPSDT enforcement. Medi-Cal Specialty Mental Health Claims data and Medi-Cal enrollment data obtained from the California Department of Mental Health will be used. PUBLIC HEALTH RELEVANCE: The lack of mental health access and treatment for children and adolescents is a serious public health problem raised by the Surgeon General in his 2000 report. Low access is especially pronounced among ethnic minority populations for whom mental illness is becoming a significant problem: in May 2007, the CDC issued a report stating that suicide was the fourth leading cause of death among youth, and that the highest rates have occurred among minority populations1. The proposed study will provide information for policymakers and administrators to understand the conditions under which existing financing and delivery systems can be levered to rapidly expand access and improve care for these children and youth. 1 Bernard SJ, Paulozzi LJ, Wallace DL; Centers for Disease Control and Prevention (CDC) (2007). Fatal injuries among children by race and ethnicity--United States, 1999-2002. MMWR Surveill Summ. May 18;56(5):1-16.