Policy Impacts on Behavioral Health Care Disparities

政策对行为医疗保健差异的影响

• 批准号: 9392722
• 负责人: JOSHUA A BRESLAU
• 金额: $ 23.08万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 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/9392722
• 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; Future; General Population; Geographic Locations; Geography; Goals; Health; Health Insurance; Health Policy; Health Services; Health Services Accessibility; Health Services Research; 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; Privatization; 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; Time trend; Uninsured; Variant; Violence; behavioral health; care burden; cost; disparity reduction; ethnic disparity; ethnic minority population; federal policy; follow-up; geographic difference; health care delivery; health care disparity; health disparity; health service use; improved; insight; member; mortality; parity; physical conditioning; preference; programs; public health relevance; racial disparity; social; social inequality; treatment disparity; trend; young adult

 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.

 描述（由申请人提供）：本提案的目标是响应 RFA-MD-15-001“系统级卫生服务和健康差异政策研究 (R01)”，旨在研究近期旨在提高普通人群行为卫生保健利用率和质量的政策变化是否对护理中的种族/民族差异产生了积极影响。尽管精神疾病的有效治疗方法已广泛普及，但治疗在人群中的分配仍然不公平。医学研究所的一份具有里程碑意义的报告将精神卫生保健中的种族和民族差异定义为不归因于健康状况或治疗偏好的接受护理的差异，这种差异在行为卫生保健的利用和质量上一直存在。差异 在治疗跨种族/少数族裔人口的精神和药物滥用疾病方面尤其令人担忧，因为这些疾病在整个成人生命历程中产生不利影响，包括对暴力暴露、家庭组成、教育程度、就业、收入和死亡率的影响。种族/少数族裔成员面临的治疗障碍可能会加剧已有的社会劣势，并导致更广泛的社会不平等现象的持续存在。 该项目审查了最近的四项州和联邦政策举措：1) 要求年轻人有资格在 26 岁之前继续享受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) 扩大管理式医疗，以及 4) 心理健康平等。虽然这些政策中的每一项都对人口水平产生有益影响，但它们对护理差异的影响尚未得到研究。这是我们知识中的一个关键差距，因为提高普通人群护理利用率和质量的计划可能会对差异产生中性甚至负面影响。每项政策的州级差异（在某些情况下早于联邦立法）提供了一个机会来凭经验评估其对差异的影响。该项目将首先利用全国最大的行为健康监测调查——全国药物使用和健康调查来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小组调查来检查一组补充结果，该调查的样本量较小，但提供了有关成本和护理质量的更多详细信息，这对于了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，以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所承受的精神和药物滥用障碍的不成比例的负担。