Can Medicaid Benefits Reduce Access Disparities for Minority Children & Youth?

描述（申请人提供）：这项研究的目的是检查医疗补助的积极执行，（Medi-Cal的）早期定期筛查诊断和治疗计划（EPSDT），以了解是否通过提供慷慨的资金，增加治疗能力，参与社区项目和组织将带来预期的政策效果，即在低收入人群中均衡支出和治疗模式，收入白色和少数民族儿童和青年。 研究目的是：1）估计加州的EPSDT心理健康计划的扩展在多大程度上减少了非洲裔美国人、拉丁裔和美洲土著人Medi-Cal入学儿童和青年的支出差距。确定支出差距的减少有多少是立即的，以及它在多大程度上构成了少数民族-白人的趋同趋势。2)估计加州实施EPSDT心理健康服务减少非洲裔美国人、拉丁裔和美洲土著Medi-Cal注册儿童和青少年获得机会差异的程度（通过总体渗透率、门诊治疗渗透率和危机治疗渗透率衡量）。确定在多大程度上减少了获得不平等是立即的，它在多大程度上构成了少数民族-白人的趋同趋势。3)对上文1和2中所述的每项从属措施进行估计，以确定减少少数族裔-白人差距与以下因素相关的程度：a）总供应商供应和西班牙语供应商供应的增加;以及B）与社区组织（包括关注少数族裔的组织）的接触增加。 使用面板数据多元回归方法在一种“中断的时间序列”的方法（Shadish，库克和坎贝尔，2002年），我们控制的因素与积极EPSDT的执行，可能混淆我们的评估其对成本和访问的差距的影响。我们将在48个季度（1992年7月至2004年6月）和整个加州县的精神卫生计划中观察EPSDT实施前后的成本和渗透率。由于我们的重点是随着时间的推移，少数民族和白人之间的差异的变化，任何潜在的混淆必须不同地影响少数民族或白人影响研究结果。为了进一步检验假设，我们对比了子样本中受EPSDT实施影响最小和不受其影响的差异。将使用从加州精神卫生部获得的Medi-Cal专科精神健康声明数据和Medi-Cal入组数据。 公共卫生相关性：儿童和青少年得不到心理健康服务和治疗，是公共卫生局局长在其2000年报告中提出的一个严重的公共卫生问题。在少数民族人口中，获得治疗的机会特别少，对他们来说，精神疾病正在成为一个严重的问题：2007年5月，疾病预防控制中心发表了一份报告，指出自杀是青年人死亡的第四大原因，少数民族人口的自杀率最高。拟议的研究将为政策制定者和管理人员提供信息，以了解现有融资和交付系统可在何种条件下得到改进，从而迅速扩大这些儿童和青年的获得机会并改善其护理。1 Bernard SJ，Paulozzi LJ，Wallace DL;美国疾病控制与预防中心（CDC）（2007）。1999-2002年美国按种族和族裔分列的儿童致命伤害情况。MMWR调查总结May 18;56（5）：1-16.

DESCRIPTION (provided by applicant): The study goal is to examine the aggressive enforcement of Medicaid's (Medi-Cal's) Early Periodic Screening Diagnosis and Treatment program (EPSDT) to learn whether reducing important structural barriers to public mental health care by providing generous financing, increasing treatment capacity, and engaging with community-based programs and organizations will bring about the desired policy effect of equalizing spending and treatment patterns among low-income white and ethnic minority children and youth. Study aims are: 1) Estimate the extent to which California's EPSDT mental health program expansion reduced disparities in spending for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in spending disparities was immediate and how much it constituted minority-white convergence in trends. 2) Estimate the extent to which California's enforcement of EPSDT mental health services reduced disparities in access (measured by overall penetration rates; outpatient treatment penetration rates; and crisis treatment penetration rates) for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in access disparities was immediate and how much it constituted minority-white convergence in trends. 3) Estimate for each dependent measure described in 1 and 2 above the extent to which reduced minority-white disparities was associated with: a) increases in total provider supply and Spanish-speaking provider supply; and b) increased engagement with community-based organizations including those with an ethnic minority focus. Using panel data multivariate regression methods in a kind of "interrupted time-series" approach (Shadish, Cook & Campbell, 2002), we control for factors correlated with aggressive EPSDT enforcement that could confound our assessment of its impact on cost and access disparities. We will observe costs and penetration rates before and after EPSDT enforcement over 48 quarters (July 1992 - June 2004) and across the 57 California county mental health plans. Since our focus is on changes in disparities between ethnic minorities and whites over time, any potential confounds must differentially affect ethnic minorities or whites to influence study results. To further test hypotheses, we contrast disparities in sub-samples minimally affected by, and unaffected by, EPSDT enforcement. Medi-Cal Specialty Mental Health Claims data and Medi-Cal enrollment data obtained from the California Department of Mental Health will be used. PUBLIC HEALTH RELEVANCE: The lack of mental health access and treatment for children and adolescents is a serious public health problem raised by the Surgeon General in his 2000 report. Low access is especially pronounced among ethnic minority populations for whom mental illness is becoming a significant problem: in May 2007, the CDC issued a report stating that suicide was the fourth leading cause of death among youth, and that the highest rates have occurred among minority populations1. The proposed study will provide information for policymakers and administrators to understand the conditions under which existing financing and delivery systems can be levered to rapidly expand access and improve care for these children and youth. 1 Bernard SJ, Paulozzi LJ, Wallace DL; Centers for Disease Control and Prevention (CDC) (2007). Fatal injuries among children by race and ethnicity--United States, 1999-2002. MMWR Surveill Summ. May 18;56(5):1-16.