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Racial and Ethnic Disparities in the Treatment of a Medicaid Population with Schizophrenia

Authors

  • Marcela Horvitz-Lennon,

    1. University of Pittsburgh Medical School, 201 North Craig St., #250, Pittsburgh, PA 15213,
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    • Address correspondence to Marcela Horvitz-Lennon, M.D. M.P.H., University of Pittsburgh Medical School, 201 North Craig St., #250, Pittsburgh, PA 15213; e-mail: horvitzlennonmv@upmc.edu. Thomas G. McGuire, Ph.D., and Richard G. Frank, Ph.D., are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Margarita Alegria, Ph.D., is with the Center for Multicultural Mental Health Research, Cambridge Health Alliance/Harvard Medical School, Somerville, MA.

  • Thomas G. McGuire,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA,
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  • Margarita Alegria,

    1. Center for Multicultural Mental Health Research, Cambridge Health Alliance/Harvard Medical School, Somerville, MA
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  • Richard G. Frank

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA,
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Abstract

Objective. To assess health care disparities among black and Latino adults with schizophrenia receiving services during the period July 1994–June 2006, and to evaluate trends in observed disparities.

Data Sources. Administrative claims data from the Florida Medicaid program. Data sources included membership files (demographic information), medical claims (diagnostic, service, and expenditure information), and pharmacy claims (prescriptions used and expenditures).

Study Design. We identified adults with at least two schizophrenia claims during a fiscal year. We used generalized estimating equation models to estimate disparities in spending on psychotropic drugs, psychiatric inpatient services, all mental health services, and all health services.

Principal Findings. Spending on psychotropic drugs, mental health, and all health was 0.9–70 percent lower for blacks and Latinos than for whites. With the exception of blacks with substance use disorder comorbidity, minorities were less likely than whites to use psychiatric inpatient services. Psychiatric inpatient spending among users did not differ by race/ethnicity. With the exception of psychiatric inpatient utilization/spending, trend analyses showed no change or modest reductions in disparities.

Conclusions. Black and Latino Medicaid recipients diagnosed with schizophrenia experience health care disparities. Some but not all disparities narrowed modestly over the study period.

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