Ethnicity and the use of outpatient mental health services in a national insured population

Objectives. 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. Methods. 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. Results. Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables. Conclusions. 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.