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

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Abstract

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.

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References

  1. Covell NH, Jackson CT, Evans AC, Essock SM (2002) Antipsychotic prescribing practices in Connecticut’s public mental health system: Rates of changing medications and prescribing styles. Schizophr Bull 28(1):17–30

    Google Scholar 

  2. Daumit GL, Crum RM, Guallar E, Powe NR, Primm AB, Steinwachs D, Ford DE (2003) Outpatient prescriptions for atypical antipsychotics for African Americans, Hispanics and Whites in the United States. Arch Gen Psychiatry 60(2):121–128

    Article  Google Scholar 

  3. Hu TW, Snowden LR, Jerrell JM (1992) Costs and use of public mental health services by ethnicity. J Ment Health Adm 19(3):278–287

    Article  Google Scholar 

  4. Kuno E, Rothbard AB (2002) Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. Am J Psychiatry 159(4):567–572

    Article  Google Scholar 

  5. Mark TL, Dirani R, Slade E, Russo PA (2002) Access to new medications to treat schizophrenia. J Behav Health Serv Res 29(1):15–29

    Article  Google Scholar 

  6. Rothbard AB, Kuno E, Foley K (2003) Trends in the rate and type of antipsychotic medications prescribed to persons with schizophrenia. Schizophr Bull 29(3):531–540

    Google Scholar 

  7. Snowden LR, Thomas K (2000) Medicaid and African American outpatient mental health treatment. Ment Health Serv Res 2(2):115–120

    Article  Google Scholar 

  8. Wang PS, West JC, Tanielian T, Pincus HA (2000) Recent patterns and predictors of antipsychotic medication regimens used to treat schizophrenia and other psychotic disorders. Schizophr Bull 26:451–457

    Google Scholar 

  9. Kuno E, Rothbard AB (2005) The effect of income and race on quality of psychiatric care in community mental health centers. Community Ment Health J 41(5):613–622

    Article  Google Scholar 

  10. Koizumi N, Kuno E, Rothbard A (2009) Distance matters in choice of mental health program: policy implications for reducing racial disparities in public mental health care. Adm Policy Ment Health Ment Health Serv Res 36:424–431

    Article  Google Scholar 

  11. Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U (2010) The predictors of patient-physician race and ethnic concordance: a medical facility fixed-effects approach. Health Serv Res 45(3):792–805

    Article  Google Scholar 

  12. Malat J, van Ryn M, Purcell D (2009) Blacks’ and Whites’ attitudes toward race and nativity concordance with doctors. J Natl Med Assoc 101(8):800–807

    Google Scholar 

  13. Kumar D, Schlundt DG, Wallston KA (2009) Patient-physician race concordance and its relationship to received health outcomes. Ethn Health 19(3):345–351

    Google Scholar 

  14. Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA (2009) Patient-provider race-concordance: does it matter in improving minority patients’ health outcomes? Ethn Health 14(1):107–130

    Article  Google Scholar 

  15. Sohler NL, Fitzpatrick LK, Lindsay RG, Anastos K, Cunningham CO (2007) Does patient-provider racial/ethnic concordance influence ratings of trust in people with HIV infection? AIDS Behav 11(6):884–896

    Article  Google Scholar 

  16. Blanchard J, Nayar S, Lurie N (2007) Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting. J Intern Med 22(8):1184–1189

    Article  Google Scholar 

  17. Brown BT, RM Scheffler, SE Tom, KE Schulman. Does the market value racial and ethnic concordance in physician–patient relationships? Health Services Res 42(2):706–726

  18. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NE (2003) Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med 139:907–915

    Google Scholar 

  19. Konrad TR, Howard DL, Edwards L, Ivanova A, Carey TS (2005) Physician-patient racial concordance, continuity of care, and patterns of care for hypertension. Am J Public Health 95(12):2186–2190

    Article  Google Scholar 

  20. King WD, Wong MD, Martin FS, Landon BE, Cunningham WE (2004) Does racial concordance between HIV-positive patient physicians affect the time to receipt of protease inhibitor? Gen Intern Med 19(11):1146–1153

    Article  Google Scholar 

  21. Saha SS, Arbelaez JJ, Cooper LA (2003) Patient-physician relationship and racial disparities in the quality of health care. Am J Public Health 93(10):1713–1719

    Article  Google Scholar 

  22. Stevens GD, Shi L, Cooper LA (2003) Patient-provider racial and ethnic concordance and parent reports of the primary care experiences of children. Ann Fam Med 1(2):105–112

    Article  Google Scholar 

  23. Ueno K 2004-08-14 Emotional consequences of racial concordance in friendship network and school context. Paper presented at the annual meeting of the American Sociological Association, San Francisco, CA. http://www.allacademic.com/meta/p110355_index.html

  24. McFadden D (1974) Conditional logit analysis of quantitative choice behavior. In: Zarembka P (ed) Frontiers in econometrics. Academic, New York, pp 105–142

    Google Scholar 

  25. Tuttle-Newhall JE et al (1997) A statewide, population-based, time series analysis of access to liver transplantation. Transplantation 63:255–262

    Article  Google Scholar 

  26. Kahn JM, Ten Have TR, Iwashyna TJ (2009) The relationship between hospital volume and mortality in mechanical ventilation: an instrumental variable analysis. Health Serv Res 44(3):862–879

    Article  Google Scholar 

  27. Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V (2007) Hospitalization of nursing home residents: the effect of state’ medicaid payment and bed-hold policies. Health Serv Res 42(4):1651–1671

    Article  Google Scholar 

  28. Hermann RC, Finnerty M, Provost S, Palmer H, Chan J, Lagodmos G, Teller T, Myrhol BJ (2002) Process measures for the assessment and improvement of quality of care for schizophrenia. Schizophr Bull 28(1):95–104

    Google Scholar 

  29. Greenberg GA, Rosenheck RA (2003) Managerial and environmental factors in the continuity of mental health care across institutions. Psychiatr Serv 54(4):529–534

    Article  Google Scholar 

  30. Druss B, Rosenheck R (1997) Evaluation of the HEDIS measure of behavioral health care quality, health plan employer data and information set. Psychiatr Serv 48(1):72–75

    Google Scholar 

  31. Fortney J, Thrill JC, Zhang M, Duan N, Rost K (2001) Provider choice and utility loss due to selective contracting in rural and urban areas. Med Care Res Rev 58(1):60–75

    Google Scholar 

  32. Phibbs CS, Luft HS (1995) Correlation of travel time on roads versus straight line distance. Med Care Res Rev 52(4):532–542

    Article  Google Scholar 

  33. Fortney J, Rost K, Warren J (2000) Comparing alternative methods of measuring geographic access to health services. Health Serv Outcomes Res Methodol 1(2):173–184

    Article  Google Scholar 

  34. Talen E (2001) School, community, and spatial equity: an empirical investigation of access to elementary schools in West Virginia. Ann Assoc Am Geogr 91(3):465–486

    Article  Google Scholar 

  35. Heard NJ, Larsen U, Hozumi D (2004) Investigating access to reproductive health services using GIS: proximity to services and the use of modern contraceptives in Malawi. Afr J Reprod Health 8(2):164–179

    Article  Google Scholar 

  36. Hosmer DW Jr, Lomeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New York

    Book  Google Scholar 

  37. Greene WH (2003) Econometric analysis, 5th edn. Prentice Hall, Upper Saddle River

    Google Scholar 

  38. McCarthy IM, Tchernis R (2010) Search costs and medicare plan choice. Health Econ 19:1142–1165

    Article  Google Scholar 

  39. Scuffham PA, Whitty JA, Taylor M, Saxby R (2010) Health system choice: a pilot discrete-choice experiment eliciting the preferences of British and Australian citizens. Appl Health Econ Health Policy 8(2):89–97 (9)

    Article  Google Scholar 

  40. Arendts G, Howard K, Rose JM (2010) Allocation decisions and patient preferences in emergency medicine. Emerg Med J, Published online: doi:10.1136/emj.2010.099929

  41. Train KE (2003) Discrete choice methods with simulation. Part I, Chapter 2, pp. 25–27, Cambridge University Press

  42. DeMaris A (1991) A framework for the interpretation of first-order interaction in logit modeling. Psychol Bull 110(3):557–570

    Article  Google Scholar 

  43. Ai C, Norton EC (2003) Interaction terms in logit and probit models. Econ Lett 80:123–129

    Article  Google Scholar 

  44. Norton EC, Wang H, Ai C (2004) Computing interaction effects and standard errors in logit and probit models. Stata J 4(2):154–167

    Google Scholar 

  45. Brambor T, Clark WR, Golder M (2006) Understanding interaction models: improving empirical analyses. Polit Anal 14:63–82

    Article  Google Scholar 

  46. Samnaliev M, McGovern MP, Clark RE (2009) Racial/ethnic disparities in mental health treatment in six medicaid programs. J Health Care Poor Underserved, 20(1)

  47. Community Coalition (2010) Community coalition initiatives. Retrieved November, 2010 from: http://www.dbhmrs.org/the-community-coalition-initiative.

  48. Corrigan JM, Donaldson MS, Kohn LT, Maguire SK, Pike KC (2001) Crossing the quality chasm. A new health system for the 21st century. Institute of Medicine, National Academy of Sciences, National Academies Press, Washington, DC

    Google Scholar 

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Acknowledgments

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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Authors and Affiliations

  1. School of Public Policy, George Mason University, 3401 North Fairfax Drive, Arlington, VA, 22201, USA

    Naoru Koizumi

  2. School of Social Policy and Practice and School of Medicine, Department of Psychiatry: Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, USA

    Aileen B. Rothbard

  3. Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA, USA

    Tony E. Smith

  4. School of Public Policy, George Mason University, Arlington, VA, USA

    Jeremy D. Mayer

Authors
  1. Naoru Koizumi
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  2. Aileen B. Rothbard
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  3. Tony E. Smith
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  4. Jeremy D. Mayer
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Correspondence to Naoru Koizumi.

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Koizumi, N., Rothbard, A.B., Smith, T.E. et al. Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans. Health Care Manag Sci 14, 314–323 (2011). https://doi.org/10.1007/s10729-011-9164-9

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  • DOI: https://doi.org/10.1007/s10729-011-9164-9

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