Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 8, Issue 3, 2005. Pages: 131-143 Published Online: 20 September 2005 Copyright © 2005 ICMPE.

* Correspondence to: Euna Han, MPH, Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, 1103A McGavran-Greenberg Hall, CBZ7411, Chapel Hill, NC 27599-7411.
Tel.: +1-919-914 6591
Fax: +1-919-966 6961
E-mail: eunhan@email.unc.edu 

Source of Funding: None declared.

Abstract

This study is intended to document a racial disparity in psychiatric drug use in both extensive and intensive margins between Whites and racial minorities using the multi year Medical Expenditure Panel Survey. We derived estimates of the actual expenditure on prescription drug use for people with specified mental illnesses from the two-part model. Results showed that Blacks, Hispanics, and Asian-Indians were less likely than Whites to use prescription drugs by 8.3, 6.1 and 23.6 percentage points, respectively, ceteris paribus. Blacks, Hispanics, and Asian-Indians with the specified mental illnesses were estimated to spend $606.53, $9.83 and $179.60 less per year, respectively, on their actual prescription drugs than Whites even after adjusting for the different likelihood of using those prescription drugs. The results imply that it is crucial to understand the underlying non-socioeconomic factors which may significantly determine the access to mental health service in the development of mental health policy.

Background: Racial minorities are a rapidly growing portion of the US population.  Research suggests that racial minorities are more vulnerable to mental illness due to risk factors, such as higher rates of poverty.  Given that the burden of mental illnesses is significant, equal likelihood of mental health services utilization is important to reduce such burden. Racial minorities have been known to use mental health services less than Whites. However, it is unclear whether racial disparity in prescription drug use for mental illnesses exists in a nationally representative sample. For a valid estimation of prescription drug use patterns, the characteristic in the distribution of prescription drug use should be accounted for in the estimation model. Aims of the Study: This study is intended to document whether there was a disparity in psychiatric drug use in both extensive and intensive margins between Whites and three racial minorities: Blacks, Hispanics, and Asian-Indians.   The study looked at several specified mental illnesses, controlling for underlying health status and other confounding factors. Methods: Secondary data analysis was conducted using the multiyear Medical Expenditure Panel Survey (MEPS), a nationally representative panel sample from 1996 through 2000. This analysis provides estimates of the actual expenditure on prescription drug use for people with specified mental illnesses for this study, based on comparison of Whites and other racial minorities. We derived the estimates from the two-part model, a framework that adjusts the likelihood of using prescription drugs for the specified mental illnesses while estimating the total actual expenditures on prescription drugs among the users. Results: This study found that Blacks, Hispanics, and Asian-Indians were less likely than Whites to use prescription drugs by 8.3, 6.1 and 23.6 percentage points, respectively, holding other factors constant in the sample, with at least one of the specified mental illnesses. The expenditure on prescription drugs for the specified mental illnesses differs between each of racial minorities (Blacks, Hispanics, and Asian-Indians) and Whites even after adjusting for the different likelihood of using those prescription drugs. Blacks, Hispanics, and Asian-Indians with the specified mental illnesses were estimated to spend $606.53, $9.83 and $179.60 less per year, respectively, on their actual prescription drugs than Whites. Discussion: This study concludes that three racial minorities: Blacks, Hispanics, and Asian-Indians, with the specified mental illnesses are less likely to use psychiatric drugs than Whites. Among users, racial minorities use less psychiatric drugs than Whites in terms of actual spending on those drugs. Implications for Health Care Provision and Use:  There is a need to focus on a program to reach out to racial minorities with a diagnosis of mental illnesses, and this program should consider the cultural specificity of each minority group regarding mental illnesses. Implications for Health Policies: In the development of mental health policy, it is crucial to understand the underlying non-socioeconomic factors which may significantly determine the access to mental health service. Also, education programs or other outreach programs for racial minorities are necessary to understand the different distribution of mental health services for racial minorities. Implications for Further Research: Future research should examine the causes for racial disparity in the use of prescription drugs for mental illness both in the extensive and intensive margins. An in-depth analysis is needed to map out the attributes for the observed disparity between Whites and racial minorities in mental health service use.

Received 26 July 2004; accepted 21 August 2005

Copyright © 2005 ICMPE