Document Type

Working Paper

Publication Date



mental health care, health insurance, empirical research, race, income

Subject Category

Health Law | Insurance Law | Law


In previous work (Richman 2007), we found that even under conditions of equal insurance coverage and access to mental healthcare providers, whites and high-income individuals consume more outpatient mental health services than nonwhites and low-income individuals. We follow-up that study to determine (1) whether nonwhite and low-income individuals obtain medical substitutes to mental healthcare, and (2) whether disparate consumption leads to disparate health outcomes. We find that nonwhites and low-income individuals are more likely than their white and high-income counterparts to obtain mental health care from general practitioners over mental healthcare providers, and nearly twice as likely not to follow up with a mental health provider after hospitalization with a mental health diagnosis. We further are unable to find any evidence that this leads to adverse health outcomes. These findings echo concern expressed in Richman (2007) that low-income and nonwhite individuals might be paying for health services that primarily benefit their white and more affluent coworkers.