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The Impact of Insurance Coverage in Diminishing Racial and Ethnic Disparities in Behavioral Health Services


Address correspondence to Margarita Alegría, Ph.D., Professor, Department of Psychiatry, Harvard Medical School and Cambridge Health Alliance, 120 Beacon St., 4th Floor, Somerville, MA 02143; e-mail:



To estimate whether racial/ethnic behavioral health service disparities are likely to be reduced through insurance expansion coverage expected through the Affordable Health Care Act.

Data Sources

Pooled data from the nationally representative NIMH Collaborative Psychiatric Epidemiological Studies (2001–2003).

Study Design

We employ a novel reweighting method to estimate service disparities in the presence and absence of insurance coverage.

Data Collection

Access to care was assessed by whether any behavioral health treatment was received in the past year. Need was determined by presence of prior year psychiatric disorder, psychiatric diagnoses, physical comorbidities, gender, and age.

Principal Findings

Improving patient education and availability of community clinics, combined with insurance coverage reduces service disparities across racial/ethnic groups.However, even with expanded insurance coverage, approximately 10 percent fewer African Americans with need for behavioral health services are likely to receive services compared to non-Latino whites while Latinos show no measurable disparity.


Expansion of insurance coverage might have different effects for racial/ethnic groups, requiring additional interventions to reduce disparities for all groups.

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