Race, Managed Care, And The Quality Of Substance Abuse Treatment

Abstract

The adoption of managed behavioral health care by state Medicaid agencies has the potential to increase the quality of treatment for racial minorities by promoting access to substance abuse treatment and creating more appropriate utilization patterns. This paper examines three indicators of quality for white, Black, and Hispanic Medicaid clients who received substance abuse treatment in Massachusetts between 1992 and 1996. It evaluates whether a managed behavioral health care carve-out in FY1993 had a positive or negative effect on access, continuity of care, and 30-day re-admissions. Prior to managed care, access and continuity were worse for minorities than for whites. For all clients under managed care, access and continuity improved between 1992 and 1996. Access improved more for Hispanic clients relative to other racial groups. Continuity improved more for Black clients relative to other racial groups. Although seven-day and 30-day re-admissions also increased following managed care, the rate of increase was not significantly greater for minorities. Although managed care had a beneficial impact on the quality of treatment for minority clients, the percent of minority Medicaid-eligible clients who accessed treatment and the percent who achieved continuity of care remained lower than for whites in every year of the study. Managed care reduced, but did not overcome, racial disparities in behavioral health care.

Race, Ethnicity, and the Use of Services for Mental Disorders

“…The relative accessibility of primary care physicians and the limitations that most health insurance plans put in place to control the use of specialty mental health care make this the most likely pattern of use. [33][34][35] The large per- Table 1 footnotes. Minimally adequate treatment was defined as receiving appropriate pharmacotherapy combined with at least 4 visits to any physician or at least 8 visits (of at least 30 minutes) with any health care or human services professional.…”

Ethnic differences in utilization of drug treatment services and outcomes among Proposition 36 offenders in California

“…Some studies indicate that minority groups, compared to Whites, experience better or equal access to and utilization of treatment services (Daley, 2005;Niv & Hser, 2006;Yang, Huang, & Hser, 2006), with an overrepresentation of minorities in some substance abuse treatment programs (De La Rosa, Khalsa, & Rouse, 1990;Desmond & Maddux, 1984;Hanson, 1985;Jung, 2000;Kopstein & Roth, 1998;SAMHSA, 2002;Schmidt & Weisner, 1993;Yang et al, 2006). Other evidence indicates that ethnic disparities do occur, with minorities experiencing reduced access to drug treatment (Little, 1981;Lundgren, Amodeo, Gerguson, & Davis, 2001;Rhodes et al, 1990;Robles et al, 2003;Rounsaville & Kleber, 1985;Wu, ElBassel, Gilbert, Piff, & Sanders, 2004;Wu, Kouzis, & Schlenger, 2003), fewer services (Wells, Klap, Koike, & Sherbourne, 2001), shorter treatment stays (Agosti, Nunes, & Ocepeck-Welikson, 1996;Evans, Spear, Huang, & Hser, 2006;Longshore et al, 2004;McCaul, Svikis, & Moore, 2001;Milligan, Nich, & Carroll, 2004), or complete absence of substance abuse treatment services (Longshore, Hsieh, Anglin, & Annon, 1992).…”

Racial and Ethnic Differences in Receipt of Primary Care Services Between Medicaid Fee-for-Service and Managed Care Plans

“…In fee-forservice plans, racial and ethnic minorities are less likely than whites to identify a primary care physician (Hargraves & Hadley, 2003). The requirement that managed care enrollees identify a primary care provider could thus improve access to primary care services more for those groups that are less likely to identify a primary care provider in fee-for-service (Bindman et al, 2005;Daley, 2005). However, we did not find that the difference in establishing a usual source of care between managed care and fee-for-service beneficiaries was significantly greater among racial and ethnic minorities than among whites.…”