Exploring the Role of Public Insurance and Cultural Competence in Enhancing Treatment Access and Retention Among Racial/Ethnic Minorities
Background/Purpose:Health insurance coverage and quality of care are common factors believed to improve access for and retention of racial and ethnic minority groups in health care. However, there is little evidence that providers' acceptance of public insurance and provision of culturally responsive care decrease wait time and retention of minority populations in community-based substance abuse treatment. Drawing from organizational theories on implementation and cultural competence, we examined administrative and service related factors associated with client level responses to treatment, namely days to enter treatment and duration in treatment.
Methods:We merged survey data on program factors with administrative data on their client outcomes to capture program effects on clients' response to treatment engagement. We analyzed merged client and program data collected in 2010–2011 from publicly funded treatment programs in Los Angeles County, California. An analytical sample of 13,328 primarily African American and Latino clients nested within 104 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on count measures of days to initiate and days spent in treatment.
Results: We controlled for individual and program level factors. Individual characteristics included demographic variables and factors associated with treatment drop out (homelessness, history of mental health, HIV status and drug use severity), while program factors included size, regulation, funding and treatment modality. Results showed that programs that accepted public insurance (p < .001) and in which staff reported personal involvement (p < .01) and linkages and resources with minority communities (p < .001) were negatively associated with client wait time. Similarly, programs with culturally responsive policies and assessment and treatment practices (p< .05) were positively associated with retention in treatment, after controlling for individual and program characteristics.
Conclusions/Implications:These preliminary findings provide an evidentiary base for the role of community-based financial and cultural practices in improving accessibility and treatment adherence in a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to expand public insurance and enhance culturally competent care, are discussed.