Racial/Ethnic Disparities In Mental Health Service and Medical Care Expenditures

描述（由申请人提供）：与非拉丁裔白色美国人相比，黑人和拉丁裔人口通常接受强度或质量较低的医疗服务。在心理健康领域尤其如此。黑人和拉丁裔人口往往不太可能比非拉丁裔白人得到及时和准确的心理健康诊断，也不太可能比白人得到基于证据的心理健康治疗。尽管存在这些巨大的差距，但人们对心理健康支出的差异是否主要是由于获得护理的差异，或者是否也存在质量差异缺乏共识。 或精神卫生服务（MHS）的强度。确定在提供MHS时出现差异的点对于制定有针对性的干预措施以提高心理健康服务质量至关重要，特别是对于服务不足的少数民族人口。本研究的总体目标是回答在教育领域的不平等问题。 在有精神疾病风险的种族/少数民族人口中提供MHS。该项目的目标是：1）解决心理健康支出中的种族/民族差异是否是由于获得护理的机会差异造成的问题，或者是否也存在所提供服务强度的差异; 2）确定MHS中已知的种族/民族差异是否在心理健康需求更大的人群中更大;以及3）确定种族/民族与心理健康需求（目标2）之间的假设相互作用是否延伸到医疗服务使用中的类似劣势。为了达到研究目的，本研究建议使用纵向数据从国民健康访谈调查和连接的两年医疗支出面板调查。我的方法使用了一个有效的筛选措施的心理困扰在NHIS和MEPS，以确定不同的个人需要心理健康服务。从MEPS中前瞻性地确定感兴趣的结果（门诊心理健康支出;总体医疗保健支出）。分析方法采用多变量两部分模型（logit，GLM）来估计种族/民族的差异，在不同的需要心理健康服务的成年人之间的服务使用的概率和平均服务支出。研究结果将有助于解决MHS中种族/民族差异的起源问题。通过估计不同需求人群的服务支出，本研究将确定医疗保健系统是否对种族/少数民族人口增加的心理健康需求反应不快。研究结果可能会识别出医疗保健系统中处于不利地位的特定亚群，这些亚群可能会从提高MHS质量的举措中受益，特别是在初级保健环境中。面对卫生改革， 这项研究将提供指导，以确保为黑人和拉丁美洲人口公平分配资源，这是改善国家健康和福祉所必需的。 公共卫生相关性：拟议的研究将提供更好的理解，在精神健康和医疗保健资源的分配不平等的种族/少数民族谁具有较高的精神疾病的风险。由于大量的黑人和拉丁裔少数民族可能通过《平价医疗法》获得保险，研究结果将有助于指导制定政策，以改善弱势和服务不足人群获得精神卫生服务的机会和质量。通过引起对医疗和精神卫生服务支出的关注，研究结果可以为旨在改善医疗保健中精神卫生服务整合的医疗保健举措提供信息，特别是对少数种族/族裔。

DESCRIPTION (provided by applicant): Compared to Non-Latino White Americans, Black and Latino populations often receive health services of lower intensity or quality. This is particularl true in the area of mental health. Black and Latino populations are often less likely than Non-Latino Whites to receive timely and accurate mental health diagnoses, and less likely than Whites to receive evidence-based treatments for mental health conditions. Despite these large gaps, there is a lack of consensus whether disparities in mental health expenditures are primarily due to differences in access to care or whether there are also disparities in the quality or intensity of mental health services (MHS) among those with access. Identifying the point at which disparities occur in the delivery of MHS is critical to the development of targeted interventions to improve the quality of mental health services, particularly for underserved minority populations. The overall objective of this study is to answer questions of inequity in the delivery of MHS among racial/ethnic minority populations at-risk for mental illness. The project aims are: 1) to resolve the question of whether racial/ethnic differences in mental health expenditures are due to differences in access to care or whether there are also differences in the intensity of services provided; 2) to determine if the known racial/ethnic disparity in MHS is even greater among those with greater mental health needs; and 3) To determine if the hypothesized interaction between race/ethnicity and mental health needs (Aim 2) extends to similar disadvantages in use of medical care. To meet the study objectives, this study proposes to use longitudinal data from the National Health Interview Survey and the linked two-year Medical Expenditures Panel Survey. My approach uses a validated screening measure of psychological distress in both the NHIS and MEPS to identify individuals varying in need for mental health services. The outcomes of interest (outpatient mental health expenditures; overall medical care expenditures) are identified prospectively from the MEPS. The analytic approach employs multivariate two-part models (logit, GLM) to estimate racial/ethnic disparities in the probability of service use and in the average service expenditures among adults varying in need for mental health services. Study findings will help to resolve questions of the origin of racial/ethnic disparities in MHS. By estimating service expenditures across populations varying in need, this research will determine if the healthcare system is less responsive to the increased mental health needs of racial/ethnic minority populations. Study findings may identify particular sub- populations disadvantaged by the healthcare system that may benefit from initiatives to improve the quality of MHS, particularly in the primary care setting. In the face of health reform, this research will offer guidance to ensure equitable resource allocation for Black and Latino populations that is needed to improve the health and well-being of the nation. PUBLIC HEALTH RELEVANCE: The proposed research will provide improved understandings of inequalities in the distribution of mental health and medical care resources among racial/ethnic minorities who have an elevated risk-for mental illness. As large numbers of Black and Latino minorities are likely to gain access to insurance through the Affordable Care Act, study findings will be useful for guiding the development of policies to improve access to and quality of mental health services for vulnerable and underserved populations. By bringing attention to medical and mental health service expenditures, study findings may inform healthcare initiatives which aim to improve the integration of mental health services in medical care, particularly for racial/ethnic minorities.