Ethnicity, gender, and utilization of mental health services in a medicaid population

This study examines gender and ethnic differences in mental health utilization and expenditures in a fee-for-service Medicaid eligible population in Monroe County, New York. The analyses demonstrate that Medicaid poor are not a homogeneous population in terms of mental health utilization, and that their patterns of care use are quite unlike those generally attributed to the middle class patients. For example, Medicaid eligible males are more likely to be mental health users than females, although they are less likely to use medical services. Ethnicity appears to be a strong determinant of ambulatory mental health utilization, but not of inpatient care. Whites experience significantly higher levels of psychiatric ambulatory use than do the nonwhites. Nonwhites, on the other hand experience greater utilization of alcohol ambulatory services than do the whites. The data indicate that although mental health care cost represents at least 20% of total expenditures in this population, this cost is predictable and stable from year to year. Other analyses dealing with the cost of medical care for mental health users, and with the impact of a 'gate keeper' on mental health utilization patterns, are presented. Both clinical and public policy implications are discussed.