Age Differences in the Influence of Race, SES, and Psychiatric Morbidity on Healthcare Utilization and Expenditures

Article excerpt

ABSTRACT

We examined how race, socio-economic status (SES), and psychiatric morbidity impact healthcare service utilization and how the impact of these predictors varies for respondents 65 years of age and over compared to those under age 65. We analyze the Household Component of the 1996 Medical Expenditure Panel Survey (MEPS), focusing on 12,303 African American and white adults in the sample. Rates of service utilization and type of service utilization are compared by race, gender, and mental disorder status. Race and psychiatric morbidity differences in costs by type of service utilization are investigated. Negative binomial and OLS regression models are examined by age and gender to discern the impact of race and psychiatric morbidity net of SES. Among respondents under the age of 65, African Americans and respondents with low SES have particular patterns of service utilization-avoiding outpatient care and physician visits. This pattern of utilization yields low costs early in life, however low SES and race are predictive of higher healthcare costs among respondents over age 65. Psychiatric impairment had a strong impact on patterns of service utilization, and its impact on healthcare costs increased with age, particularly for men. Our findings suggest that patterns of health service utilization early in the life course may have a substantial impact on future health care costs, and that alleviation of mental health problems could substantially decrease health expenditures.

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Race differences in health service utilization have been shown to influence health care costs, and recent research on the Medicare elderly has demonstrated that race disparities are exacerbated by psychological comorbidity (Husaini et al., 2002, 2003a, 2003b). Psychiatric disorders may strongly influence preventive health behaviors as well as the management of illness, and especially the control of chronic illnesses such as diabetes, hypertension, and cardiovascular diseases. Only a few studies have investigated how race may influence the impact of psychiatric morbidity on service utilization and costs, (Husaini et al., 2000, 2002, 2003a, 2003b; Druss, Rohrbaugh & Rosenheck, 1999; Zhang, Rost & Fortney, 1999). Research on younger adults may find contradictory results, since younger populations are healthier and more able to forego health service utilization--and the costs associated with avoiding preventive health measures and medical treatment will not be evident until later in life. Further, elderly citizens in the United States enjoy a form of universal coverage through Medicare, and health care coverage has a strong influence on health service utilization and associated costs (Carrasquillo, Lantigua & Shea, 2001). Thus, age-specific race differences in patterns of service utilization could have a profound impact on health outcomes and the costs of care. If African Americans avoid regular health service utilization early in life, this could complicate the identification and management of chronic illnesses--thus leading to heavy service utilization and costs when African Americans are elderly.

Our study examined data from the 1996 Medical Expenditure Panel Survey (MEPS) to assess race variations in psychological morbidity, health service utilization, and healthcare costs. First, differences in utilization and medical costs were presented for whites and African Americans with and without mental health disorders. Second, while taking into account the complex sampling design of the MEPS, we estimated negative binomial regression models of health service utilization. Models of health service utilization were estimated separately across age groups (respondents age 1864 are differentiated from those over 65) and by gender, and estimates were compared across models to examine variations in effects by age. Finally, we analyzed ordinary least squares (OLS) regression models for complex sampling designs for healthcare costs by gender and age group--comparing the effects of race, mental disorder, and socioeconomic factors. …