title: The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S.
abstract: Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area's organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.
authors: Department of Psychiatry, Harvard Medical School, Center for Multicultural Mental Health Research, Somerville, MA 02478, USA. bcook@charesearch.org
authors: Benjamin Lê
authors: BL
authors: Cook
authors: Teresa
authors: T
authors: Doksum
authors: Chih-Nan
authors: CN
authors: Chen
authors: Adam
authors: A
authors: Carle
authors: Margarita
authors: M
authors: Alegría
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data*; D003155:Community Mental Health Centers / Q000600:supply & distribution; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000600:supply & distribution*; D008875:Middle Aged; D055361:Multilevel Analysis; D011204:Poverty Areas; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*