Disparities in service utilization and expenditures for individuals living at home or in the community in California, 2004-05

Background. More than 1 in 5 individuals with DD living at home or in the community in California did not receive services and did not have expenditure data reported. Service utilization and expenditures were examined for 175,595 DD assessed individuals age 3 and over. The effects of client need, predisposing factors, enabling factors, provider supply, population characteristics, and regional centers were examined.

Method. Data from the state's client master file, the state's client development evaluation report, the state's purchase of service file, population characteristics from US census data, and provider supply from state agencies were used for the analysis. All individuals who had received services (138,336) were compared with the individuals who had not received services (37,259) in California in 2004-2005. Logistic regression and OLS regression were used.

Results. Client need characteristics, older people, whites, and those on Medicaid had higher odds of receiving services. Client need characteristics, older people, and those receiving residential service were significant positive predictors of expenditures, whereas being non-white and younger were significant negative predictors. Having more intermediate care beds for DD and residential care beds for the elderly were significant negative predictors of expenditures, while more nursing home beds was a significant positive predictor. Service utilization and expenditures varied widely across regions.

Discussion. Clear gaps in access to services and expenditures by race and age show the need for further study to understand barriers to service use and expenditures and approaches that can be used to reduce these disparities.