Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans

Abstract

Objective To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES). Data Source The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013. Study Design We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls. Data Collection This study links administrative data from a managed BH organization to a commercial marketing database. Principal Findings We found that in many cases, racial/ethnic minorities had lower specialty BH expenditures/utilization, relative to whites, primarily driven by differences in service penetration. Among women, relative to whites, Asian non‐English speakers, Asian English speakers, Hispanic non‐English speakers, Hispanic English speakers, and blacks had $106, $95, $90, $48, and $61 less in total expenditures. SES explained racial/ethnic differences in treatment intensity but not service penetration. Conclusions In this population, SES was not a major driver of racial/ethnic differences in specialty BH utilization. Future studies should explore the role of other factors not studied here, such as stigma, cultural competence, and geography.

Association Between Race/Ethnicity and Disparities in Health Care Use Before First-Episode Psychosis Among Privately Insured Young Patients

“…It is well documented that there are racial, ethnic, and socioeconomic disparities in behavioral health care use in the US. White patients with psychosis have higher behavioral health care use than other racial/ethnic populations across a variety of settings, including specialist care . There are also disparities in prescription drug use, including antipsychotics; generally, prescription drug use is lower among Black or Hispanic patients with psychosis, especially use of second-generation antipsychotics .…”

“…White patients with psychosis have higher behavioral health care use than other racial/ethnic populations across a variety of settings, 1,2 including specialist care. 3 There are also disparities in prescription drug use, including antipsychotics; generally, prescription drug use is lower among Black or Hispanic patients with psychosis, 4 especially use of secondgeneration antipsychotics. 5 These disparities reflect longstanding societal biases and institutional and interpersonal racism that create barriers for patients of color, including unequal access to care, 6 language barriers, 7 clinician biases in interpretation of symptoms, [8][9][10] and health care professional shortages in underserved neighborhoods.…”