Measuring trends in mental health care disparities, 2000 2004.
OBJECTIVE
This study measured trends in disparities in mental health care by use of an improved method that applies the Institute of Medicine (IOM) definition of racial-ethnic disparities.


METHODS
Data from the 2000-2001 and 2003-2004 Medical Expenditure Panel Surveys were used to estimate trends in two global measures of racial-ethnic disparities in mental health care: having any mental health visit and total mental health care expenditure in the past year. Disparities between African Americans, Hispanics, and white Americans were examined by applying a new methodology based on the IOM definition of racial disparity that adjusts for health status and allows for mediation of racial-ethnic disparities through socioeconomic factors. Results found by use of this measure are contrasted with unadjusted means.


RESULTS
African-American-white and Hispanic-white disparities in any use of mental health care worsened from 2000-2001 to 2003-2004 when the IOM definition was used; however, these trends were not evident in the unadjusted comparison. No significant African-American-white disparities were found in total mental health expenditures. Hispanic-white disparities in total mental health expenditures were significant within each time period and increased between 2000-2001 and 2003-2004.


CONCLUSIONS
The mental health care system continues to provide less care to persons in African-American and Hispanic minority groups than to whites, suggesting the need for policy initiatives to improve services for these minority groups. Future efforts at identifying trends in disparities in mental health services should use methodologies that adjust for health status and allow socioeconomic factors to mediate differences.
Cook
Benjamin L
BL
Mathematica Policy Research Inc, Cambridge, MA 02139, USA. bcook@mathematica-mpr.com
McGuire
Thomas
T
Miranda
Jeanne
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D005006:Ethnicity; D005260:Female; D005102:Health Expenditures / Q000639:trends; D006306:Health Surveys; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D044469:Racial Groups; D014481:United States