Padgett D K, Patrick C, Burns B J, Schlesinger H J
New York University's School of Social Work, New York.
Am J Public Health. 1994 Feb;84(2):222-6. doi: 10.2105/ajph.84.2.222.
Factors affecting ethnic differences in the use of outpatient mental health services are analyzed in an insured, nonpoor population to determine if lower use by Blacks and Hispanics persists when socioeconomic and other factors are controlled.
To identify significant predictors of the probability and amount of use, insurance claims data for a population of 1.2 million federal employees insured by Blue Cross/Blue Shield in 1983 were analyzed with the Andersen and Newman model of health service utilization. Logistic and ordinary least squares regression models were estimated for each ethnic group.
Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables.
Since ethnic differences in the use of outpatient mental health services exist even in an insured, nonpoor population, factors other than lower socioeconomic status or insurance coverage--for example, cultural or attitudinal factors and service system barriers--are likely responsible. Such findings have policy implications in the current climate of health care reform to increase access to care for the underserved.
在有保险的非贫困人群中分析影响门诊心理健康服务使用中种族差异的因素，以确定在控制社会经济和其他因素后，黑人和西班牙裔较低的使用率是否依然存在。
为了确定使用概率和使用量的显著预测因素，采用健康服务利用的安德森和纽曼模型，对1983年由蓝十字/蓝盾承保的120万联邦雇员人群的保险理赔数据进行分析。对每个种族群体估计逻辑回归模型和普通最小二乘回归模型。
在控制了多个变量后，与白人相比，黑人和西班牙裔的使用概率和使用量较低。
由于即使在有保险的非贫困人群中，门诊心理健康服务的使用也存在种族差异，因此，除了社会经济地位较低或保险覆盖不足之外的其他因素——例如文化或态度因素以及服务系统障碍——可能是原因所在。这些发现对当前医疗改革背景下增加弱势群体的医疗服务可及性具有政策意义。
