Health Care Management Science

, Volume 14, Issue 4, pp 314–323 | Cite as

Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans

  • Naoru Koizumi
  • Aileen B. Rothbard
  • Tony E. Smith
  • Jeremy D. Mayer


A discrete-choice logit model was applied to study the determinants of mental health provider choice using data from a large urban county in the Northeast US. The study subjects were 9,544 adult Medicaid recipients who received outpatient treatment from the 20 Community Mental Health Center (CMHC) programs in 2001. In addition to a conventional set of variables representing client and provider characteristics, the regression model included several interaction terms to examine whether racial concordance level among patients influences the choice of an outpatient program. The results revealed that racial concordance among the clients seems to be a factor in choosing a program. In particular, Caucasian clients are much more likely to select a program with a higher percentage of Caucasian clients, even though they have to travel further. More generally, our results suggest that program choice may be driven more by the racial composition of the clients served than by spatial proximity to the program.


Community mental health services Logit model Racial disparity Racial concordance among patients 



This research was supported by a grant from NIMH (R21 #MH065307) and from the Philadelphia Department of Behavioral Health which provided data for the analysis. We are also grateful to the consultation from Dr. Eri Kuno and research assistance of Amit Patel and Jennifer Mitchell at George Mason University.

Conflict of Interest

There are no known conflicts of interest to declare.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Naoru Koizumi
    • 1
  • Aileen B. Rothbard
    • 2
  • Tony E. Smith
    • 3
  • Jeremy D. Mayer
    • 4
  1. 1.School of Public PolicyGeorge Mason UniversityArlingtonUSA
  2. 2.School of Social Policy and Practice and School of Medicine, Department of Psychiatry: Center for Mental Health Policy and Services ResearchUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Electrical and Systems EngineeringUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.School of Public PolicyGeorge Mason UniversityArlingtonUSA

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