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.
Jerrell
Jeanette M
JM
Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia 29203, USA. jerrel.jeni@sc.edu
Wieduwilt
Kristin M
KM
Macey
Dolores V
DV
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000208:ethnology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011635:Public Health Administration / Q000191:economics; D013022:South Carolina; D044465:White People / Q000523:psychology*