Policy Impacts on Behavioral Health Care Disparities

 说明(申请人提供)：本提案的目标是响应RFA-MD-15-001《关于健康差距的系统级卫生服务和政策研究(R01)》，旨在研究最近旨在改善普通人群中行为卫生保健的利用率和质量的政策变化是否对保健方面的种族/民族差别产生了积极影响。尽管治疗精神疾病的有效方法已经广泛可用，但在整个人口中分配治疗仍然不公平。精神卫生保健方面的种族和民族差异，被一份里程碑式的医学研究所报告定义为接受保健方面的差异，而不是由于健康状况或治疗偏好，一直在行为卫生保健的利用率和质量方面都被发现。差距 在治疗精神和药物使用障碍方面，种族/少数民族人口尤其令人关切，因为这些障碍对成年人的整个生命过程都有不利影响，包括对接触暴力、家庭形成、教育程度、就业、收入和死亡率的影响。种族/少数族裔群体成员面临的待遇障碍可能会加剧先前存在的社会劣势，并导致更广泛的社会不平等现象持续存在。该项目考察了四项最近的州和联邦政策倡议：1)要求年轻成年人有资格在其父母或监护人的健康保险政策上一直呆到26岁，2)将医疗补助资格扩大到那些收入不超过联邦贫困线138%的人，3)扩大管理型医疗保健，以及4)精神健康平等。虽然这些政策中的每一项都在人口一级产生了有益的影响，但它们对护理差距的影响尚未得到审查。这是我们知识中的一个严重差距，因为改善一般人口利用率和护理质量的计划可能对差异产生中性甚至负面影响。这些政策在州一级的差异，在某些情况下早于联邦立法，为从经验上评估它们对不平等的影响提供了机会。该项目将首先使用全国药物使用与健康调查，这是全国最大的行为健康监测调查，以评估每一项政策的影响以及不同地理区域的政策影响差异。然后，我们将使用医疗支出小组调查来检查一组互补的结果，该调查的样本量较小，但增加了关于成本和护理质量的详细信息，这对于理解行为健康服务的公平性非常重要。需要对最近主要卫生政策举措的影响进行实证评估，以指导未来的政策战略，以更有效地减少行为卫生保健方面的差异，并减少精神和物质使用障碍对美国种族和少数民族的不成比例的负担。

 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.