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Health Serv Res. 2019 Jun;54(3):575-585. doi: 10.1111/1475-6773.13121. Epub 2019 Feb 7.

Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans.

Author information

1
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
2
Optum®, UnitedHealth Group, San Francisco, California.
3
Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.

Abstract

OBJECTIVE:

To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES).

DATA SOURCE:

The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013.

STUDY DESIGN:

We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls.

DATA COLLECTION:

This study links administrative data from a managed BH organization to a commercial marketing database.

PRINCIPAL FINDINGS:

We found that in many cases, racial/ethnic minorities had lower specialty BH expenditures/utilization, relative to whites, primarily driven by differences in service penetration. Among women, relative to whites, Asian non-English speakers, Asian English speakers, Hispanic non-English speakers, Hispanic English speakers, and blacks had $106, $95, $90, $48, and $61 less in total expenditures. SES explained racial/ethnic differences in treatment intensity but not service penetration.

CONCLUSIONS:

In this population, SES was not a major driver of racial/ethnic differences in specialty BH utilization. Future studies should explore the role of other factors not studied here, such as stigma, cultural competence, and geography.

KEYWORDS:

behavioral health care; racial/ethnic disparities

PMID:
30734279
PMCID:
PMC6505415
[Available on 2020-06-01]
DOI:
10.1111/1475-6773.13121

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