The Costs and Benefits of Reducing Racial-Ethnic Disparities in Mental Health Care
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Step 1: Identification of Disparities
Data.
Statistical methods.
Step 2: Identifying Offset
Data.
Statistical methods.
Step 3: Estimating Total Savings
Missing Data and Variance Calculation
Results
Whites (N=3,111) | Blacks (N=1,390) | Latinos (N=1,705) | ||||
---|---|---|---|---|---|---|
Variable | N | Weighted measurea | N | Weighted measurea | N | Weighted measurea |
Acute health care expenditures ($) | ||||||
Inpatient total expenditures | 3,178.68 | 2,205.62* | 1,567.45* | |||
Mental health | 259.38 | 340.38 | 62.13* | |||
General medical | 2,919.31 | 1,865.24* | 1,505.32* | |||
ER total expenditures | 263.17 | 294.53* | 181.96* | |||
Mental health | 12.01 | 19.11* | 19.38* | |||
General medical | 251.16 | 275.41 | 162.58* | |||
Appropriate mental health care expenditures (%) | ||||||
Any outpatient mental health care | 886 | 29.1 | 215 | 18.4* | 310 | 19.2* |
Any psychotropic drug use | 1,363 | 43.3 | 295 | 22.7* | 399 | 24.2 |
Mental health status (%) | ||||||
Poor | 280 | 9.6 | 234 | 17.9* | 246 | 16.5* |
Fair | 466 | 16.2 | 247 | 18.5* | 323 | 19.3* |
Good | 1,033 | 32.5 | 451 | 31.4 | 606 | 33.8 |
Very good | 949 | 29.5 | 348 | 23.3* | 412 | 23.7* |
Excellent | 383 | 12.4 | 110 | 8.8* | 118 | 6.7* |
Sociodemographic characteristic | ||||||
Age (%) | ||||||
18–24 | 252 | 9.6 | 153 | 12.2* | 191 | 12.3* |
25–34 | 425 | 14.2 | 216 | 18.1* | 332 | 21.9* |
35–44 | 585 | 19.2 | 269 | 20.3 | 341 | 19.4 |
45–54 | 708 | 22.6 | 321 | 22.2 | 360 | 20.7* |
55–64 | 570 | 17.6 | 231 | 15.3* | 261 | 13.6* |
65–74 | 267 | 7.6 | 111 | 6.2* | 129 | 6.8* |
≥75 | 304 | 9.1 | 89 | 5.7* | 91 | 5.2* |
Female (%) | 1,862 | 58.4 | 927 | 62.2* | 1,107 | 60.5* |
Married (%) | 1,447 | 46.6 | 376 | 26.6* | 834 | 44.3* |
Poverty level (%) | ||||||
Below poverty line | 811 | 21.0 | 581 | 40.3* | 634 | 32.4* |
Near poverty | 235 | 6.0 | 135 | 9.7* | 189 | 9.2* |
Low income | 571 | 18.6 | 281 | 19.2 | 365 | 21.2* |
Middle income | 885 | 31.0 | 302 | 22.4* | 393 | 27.2* |
High income | 609 | 23.4 | 91 | 8.5* | 124 | 10.1* |
Education (%) | ||||||
Less than high school | 886 | 22.8 | 529 | 34.5* | 1,020 | 50.6* |
High school graduate | 1,165 | 38.7 | 534 | 38.8* | 403 | 26.4* |
Some college | 629 | 22.3 | 233 | 17.9* | 195 | 15.6* |
College graduate | 431 | 16.2 | 94 | 8.8* | 87 | 7.5* |
Health insurance (%) | ||||||
Private | 1,476 | 53.8 | 453 | 37.5* | 435 | 31.4* |
Medicare | 946 | 26.9 | 354 | 22.4* | 319 | 17.7* |
Medicaid | 790 | 20.2 | 546 | 36.2* | 614 | 30.8* |
Other insurance | 10 | .3 | 9 | .7 | 12 | .7 |
Uninsured | 491 | 15.9 | 273 | 19.8* | 565 | 32.0* |
Region (%) | ||||||
Northeast | 423 | 16.6 | 177 | 14.1* | 257 | 17.7* |
Midwest | 867 | 27.8 | 229 | 17.9* | 105 | 6.8* |
South | 1,230 | 36.4 | 872 | 59.6* | 593 | 34.1* |
West | 591 | 19.3 | 112 | 8.5* | 750 | 41.4* |
Any outpatient medical expenditure | Any psychotropic medication expenditure | |||
---|---|---|---|---|
Measure | M | SD | M | SD |
Whites | 28.4 | .9 | 42.5 | 1.2 |
Blacks | 20.8 | 1.2 | 25.0 | 1.5 |
Latinos | 22.2 | 1.5 | 27.6 | 1.3 |
Disparity | ||||
Between whites and blacks* | 7.7 | 1.6 | 17.5 | 2.0 |
Between whites and Latinos* | 6.3 | 1.7 | 14.9 | 1.6 |
Step 1: disparity estimation | Step 2: offset | Step 3: savings estimation (disparity × offset) | ||||
---|---|---|---|---|---|---|
Expenditure | Disparity (%) | Disparity per population | Cost per capita ($) | estimation per capita ($) | Savings per capita ($) | Total savings ($) |
Any outpatient mental health expenditure | ||||||
ER total expenditure | 7.7 | 1,285,003 | 113.74 | 136.95** | 23.21 | 29,825,633 |
Mental health | 7.7 | 1,285,003 | 113.74 | 6.10 | — | — |
General medical | 7.7 | 1,285,003 | 113.74 | 135.25** | 21.51 | 27,641,784 |
Inpatient total expenditure | 7.7 | 1,285,003 | 113.74 | 762.28** | 648.54 | 833,372,482* |
Mental health | 7.7 | 1,285,003 | 113.74 | — | — | — |
General medical | 7.7 | 1,285,003 | 113.74 | 540.83** | 427.09 | 548,810,761* |
Any psychotropic drug expenditure | ||||||
ER total expenditure | 17.5 | 2,924,153 | 99.20 | 70.75 | — | — |
Mental health | 17.5 | 2,924,153 | 99.20 | 3.49 | — | — |
General medical | 17.5 | 2,924,153 | 99.20 | 72.78 | — | — |
Inpatient total expenditure | 17.5 | 2,924,153 | 99.20 | — | — | — |
Mental health | 17.5 | 2,924,153 | 99.20 | — | — | — |
General medical | 17.5 | 2,924,153 | 99.20 | — | — | — |
Step 1: disparity estimation | Step 2: offset | Step 3: savings estimation (disparity × offset) | ||||
---|---|---|---|---|---|---|
Expenditure | Disparity (%) | Disparity per population | Cost per capita ($) | estimation per capita ($) | Savings per capita ($) | Total savings ($) |
Any outpatient mental health expenditure | ||||||
ER total expenditure | 6.3 | 1,104,244 | 113.74 | — | — | — |
Mental health | 6.3 | 1,104,244 | 113.74 | — | — | — |
General medical | 6.3 | 1,104,244 | 113.74 | — | — | — |
Inpatient total expenditure | 6.3 | 1,104,244 | 113.74 | 642.33* | 528.59 | 583,690,028* |
Mental health | 6.3 | 1,104,244 | 113.74 | 26.99 | — | — |
General medical | 6.3 | 1,104,244 | 113.74 | 596.69* | 482.95 | 533,295,096* |
Any psychotropic drug expenditure | ||||||
ER total expenditure | 14.9 | 2,625,496 | 99.20 | — | — | — |
Mental health | 14.9 | 2,626,052 | 99.20 | — | — | — |
General medical | 14.9 | 2,626,052 | 99.20 | — | — | — |
Inpatient total expenditure | 14.9 | 2,626,052 | 99.20 | 697.77* | 598.57 | 1,571,866,592* |
Mental health | 14.9 | 2,626,052 | 99.20 | 34.62 | — | — |
General medical | 14.9 | 2,626,052 | 99.20 | 662.89* | 563.69 | 1,480,273,153* |
Discussion
Conclusions
Supplementary Material
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