Major Disparities Found in MH Spending

A recent analysis of mental health care and expenditures adds to the body of evidence that blacks and Hispanics receive less mental health care than whites do, prompting more calls for widespread reforms of mental health systems and cultural competence among mental health clinicians.

Researchers used different statistical methods to capture the differences in mental health care utilization and expenditures among a nationally representative sample of 67,581 Hispanics, non-Hispanic blacks, and non-Hispanic whites enrolled in the Medical Expenditure Panel Survey (MEPS). Researchers pooled data from two points in the survey—2000-01 and 2003-04.

MEPS, launched in 1996, represents a national fact-finding set of surveys administered by the Agency for Healthcare Research and Quality within the U.S. Department of Health and Human Services. Through detailed interviews of individuals, families, providers, and other health care stakeholders, MEPS reveals the kinds of health services Americans use, how often they use them, and how much they pay for them. Information on how the services are paid for is also collected in terms of the cost, scope, and breadth of health insurance held by or accessible to U.S. workers.

In the study, lead author Benjamin Cook, Ph.D., M.P.H., analyzed MEPS data to find out if disparities in mental health care between whites and minorities—as stated in former Surgeon General David Satcher's report,“ Mental Health: Culture, Race, and Ethnicity”—had improved since the report's release in 2001.

Cook, a researcher at Mathematica Policy Research Inc., zeroed in on health care disparities between blacks, Hispanics, and whites using different statistical analyses. He included use of a statistical methodology based on the Institute of Medicine's (IOM's) definition of quality of care as defined in its report, “Unequal Treatment.”

The report defined disparities in quality of care as differences between racial and ethnic minority groups and whites that are attributable to socioeconomic factors and insurance, but not to health status and treatment preferences.

For example, the statistical analysis used to test for disparities under this definition adjusted for variables related to patients' health status (such as lower rates of depression found in various studies among blacks and Hispanics as compared with whites).

According to the findings, when the IOM definition and statistical analysis based on that definition were used, disparities in total mental health expenditure between blacks and whites increased significantly between 2000-01 and 2003-04 (p<.001).

In addition, the disparity in total mental health expenditure between Hispanics and whites increased significantly (by about $144 per person) during the same time period (p<.001).

“There are lots of ways we can approach reducing these health disparities,” Cook told Psychiatric News. Cultural competency training for physicians, recruiting more minority physicians into the workforce, and researching methods to treat minority patients more effectively are all steps that can be taken to reduce disparities in mental health care, he noted.

In addition, Cook found that being uninsured is a strong negative predictor of total mental health expenditure and having a mental health visit.“ This suggests that improving rates of health insurance among African Americans and Hispanics would go a long way toward reducing disparities in mental health care use,” he said.