In a recent study published in Psychiatric Services by Sharon-Lise Normand, the S. James Adelstein Professor of Health Care Policy (Biostatistics) and colleagues from the RAND Corporation and the New York State Department of Health, investigated the quality of care and racial-ethnic disparities among adult Medicaid beneficiaries with schizophrenia in the state of New York. The study’s findings highlight a critical need for improvement, particularly for Black beneficiaries, prompting the authors to call on Medicaid policymakers to address these disparities.
The authors used data from about 71,000 Medicaid beneficiaries diagnosed with schizophrenia to create 30 established measures to assess quality in mental healthcare (medication management, psychosocial services, appropriateness of acute outpatient services) and general healthcare (adequacy of care for chronic illness and preventive care). Using statistical models to combine the measures, they identified three quality constructs, two mental health care (medication and ambulatory) and one general medical care. They then compared the of care received between Black (43%) beneficiaries, Latinx (23%) beneficiaries, and beneficiaries of other race and ethnicity (7%) to White beneficiaries.
While the authors found some positive aspects of care – at least 90% of beneficiaries received some ambulatory mental health services and some psychosocial services – they also found racial and ethnic disparities. Relative to White beneficiaries (50th percentile), Black beneficiaries received lower mental health medication (39th percentile) and mental health ambulatory (46th percentile) care quality; Latinx beneficiaries received lower mental health medication care quality (44th percentile); beneficiaries of "Other" race and ethnicity received higher quality of care in some areas. The disparities were even more pronounced in New York City, where Black beneficiaries received lower quality care across all quality care constructs.
These results highlight a critical need for Medicaid policymakers to define and understand the factors responsible for addressing persistent disparities in access and quality of care. Such significant inequalities faced by Medicaid beneficiaries, especially Black beneficiaries, underscore the urgency for targeted interventions to improve mental healthcare access and quality for these populations.