Abstract
The purpose of this study is to examine the influence of race, geographic distance and quality on the choice of community mental health programs. The study population was comprised of adult Medicaid recipients who received outpatient treatment for serious mental illness in FY 2001. A discrete choice model was employed to examine the likelihood of choosing one program over another. Quality was measured based on follow-up after hospital discharge and continuity of care in outpatient services. Maps showing the relationship between race and the quality of care were prepared to visually confirm the results of the statistical analysis. African American and Hispanic clients were less likely to travel further for treatment, while no significant difference was found between the Caucasian and other race groups. Caucasian subjects were more likely to choose programs with a higher quality of care compared to Hispanic or African American clients. Higher income clients were, on average, traveling longer and receiving better quality of care after controlling for race. The results suggested that clients living in higher income White neighborhoods are more likely to travel longer distances for mental health treatment. Special attention must be paid to improve the quality of care in lower income minority neighborhoods to insure equity of treatment in publicly funded programs.
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Notes
Affective disorder included major depression and bipolar disorders.
Stata is able to fit McFadden’s discrete choice model by using the command to run conditional logit (clogit) and incorporating interaction terms between provider and client attributes (Stata Press 2007).
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Acknowledgments
This research was supported by a grant from NIMH (R21 #MH065307) and from the Pennsylvania Department of Health, Disparities in Mental Health Services.
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Koizumi, N., Rothbard, A.B. & Kuno, E. Distance Matters in Choice of Mental Health Program: Policy Implications for Reducing Racial Disparities in Public Mental Health Care. Adm Policy Ment Health 36, 424–431 (2009). https://doi.org/10.1007/s10488-009-0233-z
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DOI: https://doi.org/10.1007/s10488-009-0233-z