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Policy Impacts on Behavioral Health Care Disparities

政策对行为医疗保健差异的影响

基本信息

批准号：
8996860
负责人：
JOSHUA A BRESLAU
金额：
$ 50.27万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-06-24 至 2019-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8996860
关键词：
Adult Age Alcohol or Other Drugs use Caring Data Dimensions Disadvantaged Disease Drug usage Economic Burden Economics Eligibility Determination Employment Enrollment Ethnic group Evaluation Expenditure Exposure to Family Family Violence Future General Population Geographic Locations Goals Health Health Insurance Health Policy Health Services Health Services Accessibility Health Status Healthcare Household Impact evaluation Improve Access Income Institute of Medicine (U.S.)Insurance Coverage Knowledge Life Cycle Stages Light Location Low income Managed Care Medicaid Medical Mental Health Mental disorders Minority Groups Neighborhoods Outcome Parents Policies Policy Research Population Poverty Psyche structure Psychiatric therapeutic procedure Public Health Quality of Care Race Reporting Rural Sample Size Sampling Services Socioeconomic Status Statutes and Laws Substance Use Disorder Surgeon Surveys System Testing Uninsured Variant behavioral health cost ethnic minority population federal policy follow-up geographic difference health care delivery health care service utilization health disparity improved insight member mortality parity physical conditioning preference programs public health relevance social social inequality trend young adult

项目摘要

DESCRIPTION (provided by applicant): 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.