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
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
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,
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.
An abstract of "Measuring Trends in Mental Health Care
Disparities, 2000-2004," is posted at<psychservices.psychiatryonline.org/cgi/content/abstract/58/12/1533>.