Can Medicaid Benefits Reduce Access Disparities for Minority Children & Youth?

医疗补助福利能否减少少数族裔儿童获得医疗补助的不平等

基本信息

批准号：
8064289
负责人：
LONNIE Roscoe SNOWDEN
金额：
$ 24.67万
依托单位：
UNIVERSITY OF CALIFORNIA BERKELEY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-05-01 至 2013-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8064289
关键词：
21 year old Address Administrator Adolescent Adult Affect African American California Caring Cause of Death Centers for Disease Control and Prevention (U.S.)Characteristics Child Communities County Data Diagnosis Enrollment Ethnic Origin Event Goals Health Benefit Health Expenditures Health Planning Health Services Health system Healthcare Improve Access Injury Institute of Medicine (U.S.)Latino Learning Lifting Linguistics Low income Measures Medicaid Medical Mental Health Mental Health Services Mental disorders Methods Minority Native Americans Natural experiment Outpatients Pathway interactions Pattern Penetration Play Policies Policy Making Population Provider Public Health Race Reporting Role Rosa Sampling Screening procedure Series Suicide Surgeon System Testing Time United States Youth advocacy organizations base community organizations cooking cost disorder prevention early onset ethnic minority population medical specialties neglect programs public health relevance racial and ethnic safety net treatment program trend

项目摘要

DESCRIPTION (provided by applicant): The study goal is to examine the aggressive enforcement of Medicaid's (Medi-Cal's) Early Periodic Screening Diagnosis and Treatment program (EPSDT) to learn whether reducing important structural barriers to public mental health care by providing generous financing, increasing treatment capacity, and engaging with community-based programs and organizations will bring about the desired policy effect of equalizing spending and treatment patterns among low-income white and ethnic minority children and youth. Study aims are: 1) Estimate the extent to which California's EPSDT mental health program expansion reduced disparities in spending for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in spending disparities was immediate and how much it constituted minority-white convergence in trends. 2) Estimate the extent to which California's enforcement of EPSDT mental health services reduced disparities in access (measured by overall penetration rates; outpatient treatment penetration rates; and crisis treatment penetration rates) for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in access disparities was immediate and how much it constituted minority-white convergence in trends. 3) Estimate for each dependent measure described in 1 and 2 above the extent to which reduced minority-white disparities was associated with: a) increases in total provider supply and Spanish-speaking provider supply; and b) increased engagement with community-based organizations including those with an ethnic minority focus. Using panel data multivariate regression methods in a kind of "interrupted time-series" approach (Shadish, Cook & Campbell, 2002), we control for factors correlated with aggressive EPSDT enforcement that could confound our assessment of its impact on cost and access disparities. We will observe costs and penetration rates before and after EPSDT enforcement over 48 quarters (July 1992 - June 2004) and across the 57 California county mental health plans. Since our focus is on changes in disparities between ethnic minorities and whites over time, any potential confounds must differentially affect ethnic minorities or whites to influence study results. To further test hypotheses, we contrast disparities in sub-samples minimally affected by, and unaffected by, EPSDT enforcement. Medi-Cal Specialty Mental Health Claims data and Medi-Cal enrollment data obtained from the California Department of Mental Health will be used. PUBLIC HEALTH RELEVANCE: The lack of mental health access and treatment for children and adolescents is a serious public health problem raised by the Surgeon General in his 2000 report. Low access is especially pronounced among ethnic minority populations for whom mental illness is becoming a significant problem: in May 2007, the CDC issued a report stating that suicide was the fourth leading cause of death among youth, and that the highest rates have occurred among minority populations1. The proposed study will provide information for policymakers and administrators to understand the conditions under which existing financing and delivery systems can be levered to rapidly expand access and improve care for these children and youth. 1 Bernard SJ, Paulozzi LJ, Wallace DL; Centers for Disease Control and Prevention (CDC) (2007). Fatal injuries among children by race and ethnicity--United States, 1999-2002. MMWR Surveill Summ. May 18;56(5):1-16.

描述（由申请人提供）：研究目标是检查医疗补助（MEDI-CAL）的积极执行（MEDI-CAL）的早期筛查诊断和治疗计划（EPSDT），以了解是否减少重要的融资结构障碍，通过提供良好的融资，提供良好的融资，增加社区计划和组织的较小政策和既定型的既定效应，并促进既定的待遇，并使既定的待遇和既定的待遇和既定的效率来实现较小的效果，并使既定的待遇效果和既定效应，并使既定型和待遇的效果 - 和既定型的效果 - 并促进何种待遇，并使您的待遇效果和既定效应。研究目的是：1）估计加利福尼亚州的EPSDT心理健康计划的扩展在多大程度上减少了非裔美国人，拉丁美洲裔和美国原住民梅迪 - 卡尔纳入儿童和青少年的支出差异。确定即时支出差异的减少，以及趋势中少数白人融合的构成多少。 2）估计加利福尼亚州对EPSDT心理健康服务的执行程度降低了对非裔美国人，拉丁裔和美洲美洲原住民和美国原住民招募的儿童和青少年的访问差异（通过整体渗透率衡量；门诊治疗率和危机治疗率）。确定即时访问差异的减少程度，以及趋势中少数白人融合的程度。 3）估计在1和2中描述的每个因措施的估计，而不是少数族裔白人差异与降低的程度相关的程度： b）增加与基于社区的组织的参与度增加，包括少数民族的群体。使用面板数据以一种“中断的时间序列”方法（Shadish，Cook＆Campbell，2002年）中的多元回归方法，我们控制了与积极的EPSDT执行相关的因素，这些因素可能会使我们对其对成本和访问差异的影响进行评估。我们将在EPSDT执法之前和之后观察到成本和渗透率超过48个季度（1992年7月至2004年6月）以及57个加利福尼亚县的心理健康计划。由于我们的重点是随着时间的流逝，少数民族和白人之间差异的变化，因此任何潜在的混杂都必须差异化影响少数族裔或白人以影响研究结果。为了进一步检验假设，我们将受EPSDT执法的最小影响和不受影响的子样本中的差异对比。将使用从加利福尼亚的心理健康部获得的Medi-Cal专业心理健康索赔数据和Medi-CAL入学数据。公共卫生相关性：缺乏针对儿童和青少年的心理健康获取和治疗是外科医生在2000年报告中提出的严重公共卫生问题。在少数民族中，精神疾病成为一个重大问题的少数民族中尤为明显：2007年5月，疾病预防控制中心（CDC）发表了一份报告，称自杀是青年人中第四大死亡原因，而少数民族人口的最高率是最高的。拟议的研究将为政策制定者和管理人员提供信息，以了解可以利用现有的融资和交付系统的条件，以迅速扩大这些儿童和青少年的访问和改善护理。 1 Bernard SJ，Paulozzi LJ，Wallace DL；疾病控制与预防中心（CDC）（2007）。儿童因种族和种族的致命伤害 - 美国，1999- 2002年。 MMWR监视总结。 5月18日； 56（5）：1-16。