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

描述(由申请人提供)：该研究的目标是检查Medicaid(Medi-Cal)早期定期筛查诊断和治疗计划(EPSDT)的积极执行情况，以了解通过提供慷慨的资金、增加治疗能力以及参与以社区为基础的计划和组织来减少公共精神卫生保健的重要结构性障碍是否会带来预期的政策效果，即使低收入白人和少数民族儿童和青年的支出和治疗模式均等。研究的目标是：1)估计加州EPSDT精神健康计划的扩展在多大程度上缩小了非裔美国人、拉丁裔和美洲原住民Medi-Cal招收儿童和青年的支出差距。确定支出差距在多大程度上是立竿见影的，以及在多大程度上构成了少数族裔-白人趋势的趋同。2)估计加州执行EPSDT精神卫生服务在多大程度上减少了非裔美国人、拉丁裔和美洲土著Medi-Cal登记的儿童和青年在获得治疗方面的差距(以总渗透率、门诊治疗渗透率和危机治疗渗透率衡量)。确定机会差距在多大程度上是立竿见影的，在多大程度上构成了少数族裔-白人趋势的趋同。3)估计上文第1和第2项所述的每项从属措施在多大程度上缩小了少数族裔--白人之间的差距：a)提供者总供应量和西班牙语供应者供应量的增加；b)与社区组织，包括那些以少数族裔为重点的组织的接触增加。使用面板数据多元回归方法在一种“中断的时间序列”方法(Shaish，Cook&Campbell，2002)中，我们控制了与激进的EPSDT执行相关的因素，这些因素可能会混淆我们对其对成本和获取差距的影响的评估。我们将在48个季度(1992年7月至2004年6月)和57个加利福尼亚州县精神卫生计划中观察EPSDT实施前后的成本和渗透率。由于我们的重点是少数族裔和白人之间的差距随着时间的推移而发生的变化，任何潜在的混淆都必须对少数族裔或白人产生不同的影响，以影响研究结果。为了进一步检验假设，我们对比了受EPSDT实施影响最小和不受EPSDT实施影响最小的子样本中的差异。Medi-Cal专业精神健康索赔数据和从加州心理健康部门获得的Medi-Cal注册数据将被使用。 与公共卫生有关：卫生局局长在其2000年报告中提出，儿童和青少年缺乏心理卫生服务和治疗是一个严重的公共卫生问题。在精神疾病日益成为重大问题的少数民族人口中，自杀问题尤为明显：2007年5月，疾病控制与预防中心发布了一份报告，指出自杀是青年死亡的第四大原因，少数族裔人口的自杀率最高。拟议的研究将为政策制定者和行政人员提供信息，使他们了解在哪些条件下可以利用现有的筹资和交付系统来迅速扩大获得这些儿童和青年的机会并改善对他们的照料。1 Bernard SJ，Paulozzi LJ，Wallace DL；疾病控制和预防中心(CDC)(2007年)。按种族和族裔分列的儿童致命伤害--美国，1999-2002年。MMWR调查总和。5月18日；56(5)：1-16日。

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.