To the Editor: In their study of insurance parity and the use of follow-up mental health care, Dr Trivedi and colleagues1 reported that enrollees in Medicare plans that had greater cost sharing for mental health services than for other services were less likely to receive timely outpatient care following a psychiatric hospitalization. The authors reported that the interaction of race and parity was not statistically significant. However, it seems difficult to assess whether race played a role in receiving follow-up care because (1) the inclusion criteria may have excluded many individuals who could appropriately have been in the study and (2) the identification of race was limited to the categories of white, black, and other.
The inclusion criterion of at least 2 years' participation in Medicare may have been too stringent considering that the time frames for the outcome measures were 7 and 30 days. A more reasonable criterion could have been at least 6 months, which might have yielded a larger study sample, particularly from ethnically diverse communities.2
The authors recognized that the rate of follow-up care was low and acknowledged that parity alone was insufficient to raise the quality of care to acceptable levels. They provided examples of factors unrelated to insurance parity, such as the availability of mental health appointments. We believe that these factors include measures that serve as proxies for ethnicity (eg, length of time in the United States) and indicators for the levels of acculturation (eg, how much participants identify with the US culture).
Given the increasing number of ethnic minority persons in the United States and the Healthy People 2010 objectives related to mental health, we believe that policy makers and researchers must address the elements of culture embedded within the mental health goals as a way to improve the health of all US residents.3 Part of the complexity in improving access to mental health care is that it requires addressing personal beliefs about mental illness, which are culturally shaped, and strategies for engaging and retaining in treatment individuals from ethnically diverse communities. It will be important to include other measures related to ethnicity in future studies on accessing mental health care.
Financial Disclosures: None reported.
Disclaimer: Mr Lee is an independent researcher who is also affiliated with the California Department of Public Health. The views expressed are those of the authors and may not necessarily represent the policies of the California Department of Public Health.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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