Racial and Ethnic Disparity in Mental Health Care Utilization

Presenter: Jie Chen, College of Staten Island/City University of New York

Abstract

Background

Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the Mental Health Care market.

Aims

This study investigates factors associated with the racial and ethnic disparities in antidepressant drug use, outpatient physician visits, and psychotherapy utilization. We seek to determine the extent to which disparities reflect differences in observable population characteristics versus heterogeneity across racial and ethnic groups. Among the population characteristics, we are interested in identifying which factors are most important in accounting for racial and ethnic disparities in these outcomes.

Methods

Using Medical Expenditure Panel Survey (MEPS) data from 1996-2003, we estimate individual drug utilization, physician visit, and psychotherapy visit. Conditional on those who have these utilizations, we also estimate the number of utilizations and services. Blinder-Oaxaca decomposition techniques are employed to determine the extent to which disparities reflect differences in observable population characteristics versus unobserved heterogeneity across racial and ethnic groups.

Results

Caucasians have the highest antidepressant drug utilization, physician visits and psychotherapies. Differences in observable characteristics explain most of the ethnic differences in these outcomes, but not the racial disparities. Differences in language barriers and access to health care are particularly important factors in explaining disparities. In contrast, racial disparities largely reflect unobserved heterogeneity across these population groups.

Conclusions

Differences in total utilization are not well-explained by observable characteristics, and may reflect unobserved heterogeneity such as unobserved physician-patient relationships, mistrust, and cultural factors.

Implications for Policy

To limit differences in overall antidepressant drug use, policymakers must take into account cultural factors and other sources of heterogeneity.