The authors used the high option Blue Cross/Blue Shield Federal Employee Health Benefits Plan for the 1979 to 1981 period and estimated demand for mental health services by blacks, Hispanics, and whites, as well as blacks and females. Using a three-part regression model, the study examines the probability of mental health use and the level of outpatient and inpatient care.

“Both blacks and Hispanics have a lower probability of being outpatient users….Black outpatient users had 40% fewer visits than whites, and Hispanics had 38% fewer visits…Both blacks and Hispanics have a higher probability of inpatient use…The probability of being an inpatient user is highest for blacks, given that they are users of services.”

“Even when a particular diagnosis accurately reflects the patient’s problem, treatment for that particular diagnosis varies widely….This variation in treatment recommendations points to a central issue in our concluding discussion. Utilization patterns are determined not only by the patients’ willingness to follow the recommendations of their health care providers but by the providers themselves. Our findings show that blacks utilize far more inpatient services than do whites. This is the probably the result of both provider and patient behaviors. Providers may tend to refer blacks into inpatient treatment more frequently than they do whites with the same diagnosis…This pattern of referral may reflect a clinical judgment about the level of care required to treat patients of a particular ethnicity….Providers may be exhibiting racial prejudice by referring blacks and Hispanics into inpatient treatment more frequently than whites. Inpatient treatment allows providers to maintain more control over the patient…Providers’ fears and prejudices regarding the controllability and malleability of their patients may be part of the explanation for ethnic differences in patterns of mental health service utilization. Let us move away form providers here by extending this series of postulations from provider prejudice to systemic prejudice. Our social system has evolved out of racial inequities, which persist both in their unforgettable presence in history and in their less visible but clearly lingering existence in present times.”

“Another view of differential demand among ethnic groups is that they have different treatment preferences….”