Capitation and Racial and Ethnic Differences in Use and Cost of Public Mental Health Services

  • Lonnie R. Snowden
  • Neal T. Wallace
  • Soo Hyang Kang
  • Jur-Shan Cheng
  • Joan R. Bloom
Original Paper

Abstract

This study investigated racial and ethnic differences in the probability of mental health service use and costs of treatment before and after the implementation of capitated financing. Models were created to test effects on utilization and costs of African American, Latinos, and white mental health consumers. As service use and costs declined under capitation, Latino, and white levels of use and cost tended to converge. African American utilization patterns in the capitated areas tended to parallel their white counterparts. Differential rejection by, or exclusion of, African American and Latino consumers did not appear to occur in response to capitation.

Keywords

Mental health Ethnic differences African American Latino Utilization 

References

  1. Bloom, J. R., Hu, T. W., Wallace, N. T., Cuffel, B., Hausman, J. W., Sheu, M. L., et al. (2002). Mental health costs and access under alternative capitation systems in Colorado. Health Services Research, 37(2), 315–340.PubMedCrossRefGoogle Scholar
  2. Catalano, R. A., Libby, A. M., Snowden, L. R., & Cuellar, A. E. (2000). The effect of capitated financing on mental health services for children and youth: The Colorado experience. American Journal of Public Health, 90, 1861–1865.PubMedGoogle Scholar
  3. Center for Mental Health Services. (2000). The cultural competence standards in managed mental health care for four underserved/underrepresented racial/ethnic groups. Retrieved May 31, 2006, from http://www.wiche.edu/MentalHealth/Cultural_Comp/index
  4. Christianson, J. B., Manning, W. G., Lurie, N., Stoner, T. J., Gray, D. Z., Popkin, M., et al. (1995). Utah’s prepaid mental health plan: the first year. Health Affairs, 14, 160–172.PubMedCrossRefGoogle Scholar
  5. Cooper, P. L., Crum, R. M., & Ford, D. E. (1994). Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Medical Care, 32, 15–24.CrossRefGoogle Scholar
  6. Cuffel, B. J., Bloom, J. R., Wallace, N. T., Hausman, J. W., & Hu, T. W. (2002). Two-year outcomes of fee-for-service and capitated Medicaid programs for people with severe mental illness. Health Services Research, 37, 341–359.PubMedCrossRefGoogle Scholar
  7. Lopez, S., & Lopez, S. R. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In C. E. Watkins (Ed.), Handbook of psychotherapy supervision (pp. 570–588). New York: Wiley.Google Scholar
  8. Masland, M. C., Piccagli, G., Cuffel, B. J., & Snowden, L. (1996). Planning and implementation of capitated mental health programs in the public section. Evaluation and Program Planning, 19(3), 253–262.CrossRefGoogle Scholar
  9. Mechanic, D. (2003). Managing behavioral health in Medicaid. New England Journal of Medicine, 348, 1914–1916.PubMedCrossRefGoogle Scholar
  10. Ray, W. A., Daugherty, J. R., & Meador, K. G. (2003). Effect of a mental health “carve-out” program on the continuity of antipsychotic therapy. New England Journal of Medicine, 348, 1885–1894.PubMedCrossRefGoogle Scholar
  11. Snowden, L. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93, 239–242.PubMedCrossRefGoogle Scholar
  12. Snowden, L. R., Cuellar, A. E., & Libby,A. M. (2003). Minority youth in foster care: Managed care and access to mental health treatment. Medical Care, 41, 264–274.PubMedCrossRefGoogle Scholar
  13. Snowden, L. R., & Pingitore, D. (2002). Frequency and scope of mental health service delivery to African Americans in primary care. Mental Health Services Research, 4, 123–130.PubMedCrossRefGoogle Scholar
  14. Snowden, L. R., & Thomas, K. (2000). Medicaid and African American outpatient mental health treatment. Mental Health Services Research, 2, 115–120.PubMedCrossRefGoogle Scholar
  15. Stata Corp. (1997). Stata statistical software: Release 5.0. College Station. TX: Stata Corporation.Google Scholar
  16. Stoner, T., Manning, W., Christiansen, J., Gray, D. Z., & Marriott, S. (1997). Expenditures for mental health services in the Utah prepaid mental health plan. Health Care Financing Review, 18(3), 73–93.PubMedGoogle Scholar
  17. Thomas, K. C., & Snowden, L. R. (2001). Minority response to health insurance coverage for mental health services. Journal of Mental Health Policy and Economics, 4, 35–41.PubMedGoogle Scholar
  18. US Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity: A supplement to mental health: A report to the surgeon general. Rockville, MD.Google Scholar
  19. Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., & Catalano, R. (1999). Gaps in service utilization by Mexican Americans with mental health problems. American Journal of Psychiatry, 156, 928–934.PubMedGoogle Scholar
  20. Wallace, N. T., Bloom, J. R., Hu, T. W., & Libby, A. M. (2005). Psychiatric medication treatment patterns for adults with schizophrenia under Medicaid mental health managed care in Colorado. Psychiatric Services, 56(11), 1402–1408.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Lonnie R. Snowden
    • 1
  • Neal T. Wallace
    • 3
  • Soo Hyang Kang
    • 2
  • Jur-Shan Cheng
    • 2
  • Joan R. Bloom
    • 2
  1. 1.School of Social WelfareUniversity of California, BerkeleyBerkeleyUSA
  2. 2.School of Public HealthUniversity of California, BerkeleyBerkeleyUSA
  3. 3.Mark O. Hatfield School of GovernmentPortland State UniversityPortlandUSA

Personalised recommendations