Disparities in service utilization and expenditures for individuals with developmental disabilities

Background: The factors that affect access to services for individuals with developmental disabilities (DD) have not received much attention. Methods: This study examined service utilization and expenditures provided by regional centers to individuals with DD living at home and in residential settings in California in 2004-2005. Logistic regressions of secondary data were used to predict the receipt of services, and ordinary least squares regressions were used to examine the predictors of service expenditures. Results: Of the 175,595 individuals assessed with DD, 21% did not receive any purchased services from regional centers in 2004-2005. Controlling for client needs, individuals aged 3-21 years were less likely than other age groups to receive services. All racial and ethnic minority groups were less likely to receive any services than were whites. The supply of intermediate care facilities for habilitation and residential care reduced the likelihood of receiving regional center services. Of those who received services, younger individuals and all racial and ethnic minority groups had significantly lower expenditures. Provider supply, area population characteristics, and regional centers also predicted variation in service use and expenditures. Conclusion: The disparities by age, race/ethnicity, and geographic area require further study, and specific approaches are needed to ensure equity in access to services. (C) 2008 Elsevier Inc. All rights reserved.