Insurance claims data for a population of 1.2 million federal employees insured by the Blue Cross/Blue Shield in 1983 were analyzed with the Anderson and Newman model of health service utilization…. Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables. 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.

After adjusting for all covariates, “whites had 1.7 times greater odds of making a visit compared with Blacks and Hispanics (P<.004). There was no significant difference between Blacks and Hispanic odds of making a visit. In the ordinary least squares regression model, Whites were estimated to make 2.64 more mental health visits during the year than Hispanics and Blacks (P<.001). There was no significant difference found between Hispanics and Black users.”

“This study’s primary finding that Whites use more mental health services even in an insured population points to the possibility that ethnic differences may persist even under national health insurance…. Many researchers suggest that cultural or attitudinal factors play a strong role in lower use by Blacks and Hispanics… Aspects of service delivery system play a role as well…. Finally, an ignorance of the more subtle aspects of cultural and social class differences may contribute to an appearance of insensitivity and thus inhibit the pursuit of care….”