The Relationship between Service Utilization and Medicaid Enrollees’ Trust in Health Care Providers

Based on findings from 1990 National Co-morbidity Survey, it is estimated that nearly 20% of the U.S. population is affected by mental disorders during a given year. Approximately 5.4% of adults are considered to have a serious mental illness that interferes with their social function, and half of them suffer from severe and persistent mental illness (SMI). Mental illness imposes a high socioeconomic burden that is second only to cardiovascular disease (Kessler, Berglund, Zhao et al., 1996; Kessler, McGonagle, Zhao et al., 1994). Among individuals with SMI, 40% do not seek any treatment from either general medical or specialty mental health providers (Regier, Narrow, Rae et al., 1993). In addition, persons with SMI tend to have more co-morbid health and/or substance abuse conditions. They also have higher mortality rates for both natural and unnatural causes compared to the general population (Bazemore, 1996; Berren, Hill, Merikle et al., 1994; Black, Warrack, & Winoker, 1995; Newman & Bland, 1991). However, among individuals with co-morbid physical and mental health conditions, only one-third of them receive mental health treatment from either general health or mental health care providers. In Florida, evaluation results of Medicaid health services indicate between 15% and 20% of individuals with SMI did not use any mental health services. These findings lead us to question why individuals who likely should be receiving services do not use them. One theory is that the level of trust a person has in his or her provider is an important factor associated with disabled individuals\u27 use of health/mental health services