Use and Costs of Public-Sector Behavioral Health Services for African-American and White Women

OBJECTIVE: The purpose of this study was to identify differences between African-American and white women in the use of behavioral health services and factors associated with these differences. METHODS: In one large public behavioral health system, data on demographic characteristics, financial resources, clinical disorders, service use patterns, and costs of care were analyzed for 10,905 African-American and 19,069 white women between the ages of 18 and 59 years who received behavioral health services in 1997. RESULTS: The African-American women were more likely to be older, never married, unemployed, and eligible for Medicaid and to have a diagnosis of a psychotic disorder or a substance use disorder. African-American women were more likely than white women to receive inpatient substance abuse services and to receive more community-based day treatment services, medication services, and case management services. However, the costs of that care differed by only 2 to 4 percent from those for white women. Presence of a psychotic disorder and co-occurring substance use—need-related factors—were significant predictors of higher inpatient care costs for all the women in the sample. Presence of a psychotic or major affective disorder and eligibility for Medicaid—an enabling factor—were the most significant predictors of higher outpatient costs for the sample. Receipt of more community-based services was significantly and inversely related to inpatient care costs, regardless of race. CONCLUSIONS: In this sample of African-American and white women, consumers' needs were a significant predictor of service use. Patterns of care that were tailored to consumers' needs were not significantly more costly overall.