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：
8212232
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 2013-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8212232
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）：该研究的目标是检查医疗补助 (Medi-Cal) 早期定期筛查诊断和治疗计划 (EPSDT) 的积极执行情况，以了解是否可以通过提供慷慨的资金来减少公共精神卫生保健的重要结构性障碍，提高治疗能力以及参与社区方案和组织将带来预期的政策效果，即低收入白人和少数族裔儿童和青少年的支出和治疗模式均等。研究目的是： 1) 估计加州 EPSDT 心理健康计划的扩展在多大程度上减少了非裔美国人、拉丁裔和美洲原住民 Medi-Cal 注册儿童和青少年的支出差异。确定支出差异有多少是立即减少的，以及它在多大程度上构成了少数族裔与白人趋势的趋同。 2) 估计加州实施 EPSDT 心理健康服务在多大程度上减少了非裔美国人、拉丁裔和美洲原住民 Medi-Cal 登记儿童的获取差异（以总体渗透率、门诊治疗渗透率和危机治疗渗透率衡量），以及青年。确定在多大程度上减少了准入差距，以及它在多大程度上构成了少数族裔与白人趋同的趋势。 3) 估计上述 1 和 2 中描述的每项相关措施与减少少数族裔白人差异的程度： a) 总供应商供应量和西班牙语供应商供应量的增加； b) 加强与社区组织（包括关注少数民族的组织）的接触。在一种“中断时间序列”方法中使用面板数据多元回归方法（Shadish、Cook 和 Campbell，2002），我们控制了与积极的 EPSDT 执行相关的因素，这些因素可能会混淆我们对其对成本和访问差异影响的评估。我们将观察 48 个季度（1992 年 7 月至 2004 年 6 月）以及 57 个加州县心理健康计划实施 EPSDT 前后的成本和渗透率。由于我们的重点是少数族裔和白人之间的差异随时间的变化，因此任何潜在的混杂因素都必须对少数族裔或白人产生不同的影响，从而影响研究结果。为了进一步检验假设，我们对比了受 EPSDT 执行影响最小和未影响的子样本中的差异。将使用从加州心理健康部获得的 Medi-Cal 专业心理健康索赔数据和 Medi-Cal 注册数据。公共卫生相关性：儿童和青少年缺乏心理健康服务和治疗是卫生局局长在其 2000 年报告中提出的一个严重的公共卫生问题。在少数族裔人群中，自杀机会尤其明显，对于他们来说，精神疾病已成为一个严重的问题：2007 年 5 月，疾病预防控制中心 (CDC) 发布了一份报告，指出自杀是青少年的第四大死因，而自杀率最高的是少数族裔人群。人口1.拟议的研究将为政策制定者和管理人员提供信息，以了解在什么条件下可以利用现有的融资和交付系统来迅速扩大对这些儿童和青少年的服务并改善对这些儿童和青少年的照顾。 1 伯纳德 SJ、保洛齐 LJ、华莱士 DL；疾病控制和预防中心 (CDC) (2007)。按种族和民族划分的儿童致命伤害——美国，1999-2002 年。 MMWR 监测摘要。 5 月 18 日；56(5)：1-16。