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Implementing the Institute of Medicine Definition of Disparities: An Application to Mental Health Care

Authors

  • Thomas G. McGuire,

    1. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115,
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    • Address correspondence to Thomas G. McGuire, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115. Margarita Alegria, Ph.D., is with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Somerville, MA. Benjamin L., Cook, MPH, is with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Ken Wells, MD, Ph.D., is with the Neuropsychiatric Institute and Hospital, University of California at Los Angeles, Health Services Research Center, UCLA Wilshire Center, Los Angeles, CA. Alan M. Zaslavsky is with the Department of Health Care Policy, Harvard Medical School, Boston, MA.

  • Margarita Alegria,

    1. Center for Multicultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Somerville, MA,
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  • Benjamin L. Cook,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA
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  • Kenneth B. Wells,

    1. Neuropsychiatric Institute and Hospital, University of California at Los Angeles, Health Services Research Center, UCLA Wilshire Center, Los Angeles, CA
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  • Alan M. Zaslavsky

    1. Neuropsychiatric Institute and Hospital, University of California at Los Angeles, Health Services Research Center, UCLA Wilshire Center, Los Angeles, CA
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Abstract

Objective. In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care.

Data Sources. Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997–1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use.

Study Design. Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities.

Principal Findings. Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach.

Conclusions. A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

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