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

精神卫生服务和医疗支出中的种族/民族差异

• 批准号: 8417625
• 负责人: AUDREY L JONES
• 金额: $ 4.19万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8417625
• 关键词: Racial; Ethnic; Disparities; Mental; Health

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：与非拉丁裔美国白人相比，黑人和拉丁裔人口通常接受强度或质量较低的医疗服务。在心理健康领域尤其如此。黑人和拉丁裔人口通常比非拉丁裔白人更不可能获得及时、准确的心理健康诊断，也比白人更不可能接受针对心理健康状况的循证治疗。尽管存在这些巨大差距，但对于精神卫生支出的差异是否主要是由于获得护理的机会差异或是否也存在质量差异仍缺乏共识。 或有机会获得心理健康服务 (MHS) 的人的强度。确定 MHS 提供中出现差异的点对于制定有针对性的干预措施以提高心理健康服务的质量至关重要，特别是对于服务不足的少数群体。本研究的总体目标是回答不平等问题 向有精神疾病风险的种族/族裔群体提供 MHS。该项目的目标是： 1) 解决心理健康支出中的种族/族裔差异是否是由于获得护理的机会差异造成的问题，还是由于提供的服务强度也存在差异造成的问题； 2) 确定在心理健康需求较高的人群中，已知的 MHS 种族/民族差异是否更大； 3) 确定种族/民族与心理健康需求之间假设的相互作用（目标 2）是否会导致医疗保健使用中的类似劣势。为了实现研究目标，本研究建议使用全国健康访谈调查和相关的两年医疗支出小组调查的纵向数据。我的方法是在 NHIS 和 MEPS 中使用经过验证的心理困扰筛查措施来识别对心理健康服务有不同需求的个人。感兴趣的结果（门诊心理健康支出；总体医疗保健支出）是从 MEPS 中前瞻性确定的。分析方法采用多元两部分模型（logit，GLM）来估计不同心理健康服务需求的成年人在服务使用概率和平均服务支出方面的种族/民族差异。研究结果将有助于解决 MHS 中种族/民族差异的起源问题。通过估计不同需求人群的服务支出，这项研究将确定医疗保健系统是否对少数种族/族裔人口日益增长的心理健康需求反应迟缓。研究结果可能会识别出因医疗保健系统而处于不利地位的特定亚人群，这些亚人群可能会从提高 MHS 质量的举措中受益，特别是在初级保健机构中。面对医改， 这项研究将为确保黑人和拉丁裔人口的公平资源分配提供指导，这是改善国家健康和福祉所需的。 公共卫生相关性：拟议的研究将加深对精神疾病风险较高的少数族裔/族裔之间心理健康和医疗保健资源分配不平等的理解。由于大量黑人和拉丁裔少数族裔可能通过《平价医疗法案》获得保险，因此研究结果将有助于指导制定政策，以改善弱势群体和服务不足人群获得心理健康服务的机会和质量。通过引起人们对医疗和心理健康服务支出的关注，研究结果可以为医疗保健举措提供信息，这些举措旨在改善心理健康服务与医疗保健的整合，特别是针对少数族裔/族裔。