Cultural competence and quality of care: Issues for mental health service delivery in managed care

Models of mental health service delivery in managed cam have evolved without considering the needs of ethnic minorities in any systematic manner. Consequently, these new systems may pose additional barriers to access and treatment. In this article, the impact of the health care crisis on mental health service delivery to ethnic minorities in terms of access, cost, and quality of care issues in managed care systems is explored. A quality-of-care framework is used for addressing the notion of cultural competence as a critical dimension of quality of cam for ethnic minority populations. Research in minority mental health and quality of care is integrated in order to explore how various structures, processes, and outcomes in managed care systems (e.g., cost containment structures for controlling the supply and demand of mental health services, utilization management and gatekeeping processes) may impact mental health service delivery to ethnic minorities. Cultural competence is conceptualized as a critical component of quality care for ethnic minority populations.