Policy Impacts on Behavioral Health Care Disparities

 描述（由申请人提供）：响应RFA-MD-15-001“健康差异的系统级卫生服务和政策研究（R 01）”，本提案的目标是检查旨在提高普通人群行为卫生保健利用率和质量的最新政策变化是否对护理中的种族/民族差异产生了积极影响。虽然对精神疾病的有效治疗已经广泛提供，但在人口中的治疗分配仍然不公平。种族和民族差异的精神卫生保健，定义为一个具有里程碑意义的医学研究所的报告，在接受护理的差异不归因于任何健康状况或治疗偏好，一直被发现在利用和质量的行为卫生保健。差距 在种族/族裔少数群体中治疗精神病和药物使用障碍的工作尤其令人关切，因为这些障碍对整个成年生活过程产生不利影响，包括对遭受暴力、家庭组成、教育程度、就业、收入和死亡率的影响。种族/族裔少数群体成员在治疗方面面临的障碍可能加剧原有的社会不利条件，并导致更广泛的社会不平等现象持续存在。 该项目研究了最近的四个州和联邦政策举措：1）要求年轻人有资格在26岁之前继续使用父母或监护人的健康保险政策，2）将医疗补助资格扩大到收入高达联邦贫困线138%的人，3）扩大管理式护理，以及4）心理健康平等。虽然这些政策中的每一项都对人口产生了有益的影响，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关键差距，因为提高普通人群的利用率和护理质量的计划可能对差距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，提供了一个机会，以评估其对差距的影响经验。该项目将首先使用全国药物使用和健康调查，这是全国最大的行为健康监测调查，以评估每项政策的影响以及政策影响在不同地理区域的变化。然后，我们将使用医疗支出面板调查来检查一组补充结果，该调查的样本量较小，但对成本和护理质量有更多的详细信息，这对于理解行为健康服务的公平性非常重要。需要对近期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，更有效地减少行为卫生保健方面的差异，并减少美国种族和少数民族精神和物质使用障碍的不成比例的负担。

 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.