Mental Health Care for Disadvantaged Populations: The Role of the Provider Landscape

PROJECT SUMMARY/ABSTRACT Significant racial and ethnic disparities exist in the access, utilization, and quality of mental health care. People with disabilities face further intersecting disadvantages and access barriers. Improving access and quality of mental health services for disadvantaged groups requires an understanding of factors at multiple levels as well as an understanding of how these factors interact. A key gap in our knowledge is how structural factors, such as the landscape and the organization of providers, affect access, utilization, and quality of mental health care for disadvantaged groups. This project investigates the effect of the provider landscape on disparities by race, ethnicity and disability status in access, utilization and the quality of mental health care. We will combine multiple large insurance claims datasets from Medicaid, Medicare, and commercial insurers as well as novel provider organization and ownership data in order to characterize patterns and changes in the provider landscape for mental health care. We will use quasi-experimental approaches to identify the differential causal effects of the provider landscape on access, utilization, and quality of care for different groups. These quasi- experiments include changes in provider ownership structure, provider exits, and individuals moving to areas with different provider landscapes. We will also use quasi-experimental approaches to study how changes in Medicaid policy that may have differentially altered the provider landscape for mental health care across racial, ethnic and disability status groups. By identifying structural aspects of the health care system that reduce or increase disparities in mental health care, our findings will reveal targets for policy interventions to improve the mental health of disadvantaged populations across the U.S.