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Barry CL, Gabel JR, Frank RG, Hawkins S, Whitmore HH, Pickreign JD. Design Of Mental Health Benefits: Still Unequal After All These Years. Health Aff (Millwood) 2003; 22:127-37. [PMID: 14515888 DOI: 10.1377/hlthaff.22.5.127] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper examines recent trends in the design and organization of coverage for mental health care using data from a Henry J. Kaiser Family Foundation and Health Research and Educational Trust (KFF/HRET) national employer survey. Legislation and changes in the delivery of mental health services have altered how mental health insurance is bought and sold. However, our findings reveal that mental health coverage is still typically not offered at a level equivalent to coverage for other medical conditions. We attempt to synthesize these data with prior research as a foundation for informed debates.
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Abstract
OBJECTIVE This study assessed treatment rates and expenditures for behavioral health care by employers and behavioral health care patients in a large national database of employer-sponsored health insurance claims. METHOD Insurance claims from 1996 from approximately 1.66 million individuals were examined. Average annual charges per person and payments for behavioral health care were calculated along with patient out-of-pocket expenses and inpatient hospital admission rates. Behavioral health care expenditures for bipolar disorder were compared to expenditures for other behavioral health care diagnoses in these same insurance plans. RESULTS A total of 7.5% of all covered individuals filed a behavioral health care claim. Of those, 3.0% were identified as having bipolar disorder, but they accounted for 12.4% of total plan expenditures. Patients with bipolar disorder incurred annual out-of-pocket expenses of $568, more than double the $232 out-of-pocket expenses incurred by all claimants. The inpatient hospital admission rate for patients with bipolar disorder was also higher (39.1%) compared to 4.5% for all other behavioral health care claimants. Furthermore, annual insurance payments were higher for covered medical services for individuals with bipolar disorder than for patients with other behavioral health care diagnoses. CONCLUSIONS Bipolar disorder is the most expensive behavioral health care diagnosis, both for patients with bipolar disorder and for their insurance plans. For every behavioral health care dollar spent on outpatient care for patients with bipolar disorder, $1.80 is spent on inpatient care, suggesting that better prevention management could decrease the financial burden of bipolar disorder.
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Rabinowitz J, Gross R, Feldman D. Perceived need and receipt of outpatient mental health services. Factors affecting access in Israeli HMOs. J Ambul Care Manage 2003; 26:260-9. [PMID: 12856505 DOI: 10.1097/00004479-200307000-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The finance and provision of care have been suggested as variables that affect the utilization of mental health services. This study compared perceived need and receipt of outpatient mental health services in a staff-model health maintenance organization (HMO) and in three HMOs with preferred provider organization (PPO) arrangements. A national random phone survey (n = 1,394) of perceived need for and receipt of mental health assistance was conducted in Israel in 1995. Health care is provided by four HMOs that differ in mental health benefits, utilization management (i.e., prior authorization and referral requirements), and availability of mental health services (i.e., pool of providers and geographic dispersal). About one-quarter of the respondents had perceived a need for help at some time in their life. Significantly fewer respondents from the HMO with a small pool of providers got help (20%) than respondents from the other HMOs, which had almost identical rates of obtaining care (40.3%, 37.3% and 40.3%). Providing generous outpatient mental health care benefits does not appear to increase the proportion of persons in need who get help. However, severely limiting the availability of services does reduce the proportion of persons getting care. Implications for regulating insurers are discussed.
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Slade EP, Anderson GF. Health plan options at fortune 100 companies: available coverage for mental health care consumers. Psychiatr Serv 2003; 54:815-7. [PMID: 12773593 DOI: 10.1176/appi.ps.54.6.815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martin A, Leslie D. Psychiatric inpatient, outpatient, and medication utilization and costs among privately insured youths, 1997-2000. Am J Psychiatry 2003; 160:757-64. [PMID: 12668366 DOI: 10.1176/appi.ajp.160.4.757] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined trends in use of inpatient and outpatient mental health services, including pharmacotherapy, among privately insured children and adolescents from 1997 to 2000. METHOD Data from a national database of more than 1.7 million privately insured individuals were used in an analysis of inpatient, outpatient, and pharmacy claims of users of mental health care age 17 years and younger (approximately 20,000 patients per year). Annual utilization rates and adjusted costs for services and dispensed psychotropic medications were calculated. Results from 1997 and 2000 were compared across diagnostic and age categories. RESULTS The proportion of youths with an inpatient psychiatric admission decreased by 23.7% from 1997 to 2000, and annual inpatient and outpatient costs decreased by 1,216 US dollars (18.4%) and 157 US dollars (14.4%), respectively. Decreases were driven by a reduction in inpatient days (20.0%) and by a combination of a reduction in outpatient visits (11.3%) and declining payments per outpatient visit (6.1%). Payment trends across diagnoses varied considerably, with the largest reductions seen in treatment of depression, hyperactivity, adjustment disorders, and anxiety disorders. Over the same period, the proportion of youths receiving medication increased by 4.9%, and mean annual medication-related costs per outpatient increased by 41 US dollars (12.1%). CONCLUSIONS Reductions in inpatient and outpatient mental health service intensity and reimbursements documented in previous research continued through the late 1990s. Declines were accompanied by concurrent increases in the use of and costs associated with psychotropic medications, particularly for youths with mood and anxiety disorders. These results document a shift toward medication-based outpatient treatment modalities.
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Mark TL, Coffey RM. What drove private health insurance spending on mental health and substance abuse care, 1992-1999? Health Aff (Millwood) 2003; 22:165-72. [PMID: 12528848 DOI: 10.1377/hlthaff.22.1.165] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Trends in MH/SA treatment spending from 1992 to 1999 were examined using employer claims data from approximately 1.7 million covered lives in each year. The analysis finds that employer-based private insurance spending on MH/SA treatment did not keep pace with total employer-based private insurance spending or general price inflation. MH/SA spending dropped from 7.2 percent of total private insurance spending in 1992 to 5.1 percent in 1999. The decline was attributable to a dramatic decrease in inpatient MH/SA treatment--specifically, the probability of admissions and average length-of-stay.
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Fortney JC, Booth BM, Kirchner JE, Williams DK, Han X. Differences between physical and behavioral health benefits in the health plans of at-risk drinkers. Psychiatr Serv 2003; 54:97-102. [PMID: 12509674 DOI: 10.1176/appi.ps.54.1.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this study was to describe the physical and behavioral health benefits of a representative community-based sample of at-risk drinkers potentially in need of behavioral health services. METHODS A screening instrument for at-risk drinking was administered by telephone to a random community sample of more than 12,000 adults. A telephone interview was conducted with the health plans of 294 at-risk drinkers who were insured and who consented to the release of their insurance records to collect information about supply-side cost-containment strategies (for example, gatekeeping and restrictions on choice of provider), and demand-side cost-containment strategies (for example, deductibles, limits, coinsurance, and copayments). Information about health plan characteristics was successfully collected for 217 (72 percent) of the insured at-risk drinkers, representing 113 different health plans and 206 different policies. RESULTS Both provider choice restrictions and gatekeeping were more likely to be used for behavioral health care than for physical health care. Greater cost-sharing for mental health than for physical health was most often achieved by using additional limits (83 percent) and higher coinsurance (66 percent) and less often achieved by using higher copayments (38 percent) and additional deductibles (13 percent). The greater cost-sharing for behavioral health amounted to a 30 percent ($42) difference in annual out-of-pocket costs for an average user of behavioral health services compared with full parity. CONCLUSIONS The results provide information to advocacy groups and policy makers about how much equalization would have to occur in the insurance market before full parity could be achieved between physical health and behavioral health benefits for a population of individuals potentially in need of behavioral health services.
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Bryant-Comstock L, Stender M, Devercelli G. Health care utilization and costs among privately insured patients with bipolar I disorder. Bipolar Disord 2002; 4:398-405. [PMID: 12519100 DOI: 10.1034/j.1399-5618.2002.01148.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study examined health care resource utilization and direct health care costs among patients diagnosed with bipolar I disorder in a privately insured population. METHODS Health care claims data for 2883 patients with a primary diagnosis of bipolar disorder were compared over a 1-year period (1997) with claims data for 2883 randomly selected, age- and sex-matched, non-bipolar patients, all covered under the same large private insurer in USA. Resource use (i.e. original and refill pharmaceutical dispensing, medical and procedural services received, inpatient hospitalization, outpatient services, physician visits and emergency room treatment) and their costs are described overall, as well as by bipolar disorder diagnosis (based on ICD-9 codes) and type of care (i.e. mental health versus non-mental health). RESULTS Bipolar patients utilized nearly three to four times the health care resources and incurred over four times greater costs per patient compared with the non-bipolar group during the 1-year period ($7663 versus $1962). Inpatient care (hospitalizations) accounted for the greatest disparity between groups, as it was the single-most costly resource in the bipolar group ($2779 versus $398). Patients with bipolar depression (among the single bipolar diagnostic categories of mixed, manic or depressed) incurred the highest health care costs. While mental health care cost was a significant component of total cost in the bipolar group, it accounted for only 22% of the total per-patient cost; in comparison, it accounted for only 6% of the total per-patient cost in the non-bipolar group. CONCLUSION Treatment of bipolar disorder, particularly inpatient care, is costly to patients and health insurers. Further study is needed to find ways to reduce the overall cost of managing these patients without jeopardizing patient care.
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Bao Y. Predicting the use of outpatient mental health services: do modeling approaches make a difference? INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2002; 39:168-83. [PMID: 12371570 DOI: 10.5034/inquiryjrnl_39.2.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Studies attempting to project the impact of providing health coverage to the uninsured population have demonstrated considerable variation in the estimated costs of mental health care. Different modeling approaches to project health care use and costs have been shown to address some data characteristics well, but not all of them. Using data from Health Care for Communities, a recent national household survey, this paper attempts to estimate and predict the use of mental health outpatient services if insurance coverage were extended to the uninsured. The study employs two-part models, with the second part based on an ordinary least squares (OLS) approach and a generalized linear model (GLM), and a zero-inflated negative binomial model (ZINB). Estimates and predictions are not sensitive to the modeling approaches chosen, although the ZINB model out performs the two-part models in terms of out-of-sample prediction.
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Edlund MJ, Wang PS, Berglund PA, Katz SJ, Lin E, Kessler RC. Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 2002; 159:845-51. [PMID: 11986140 DOI: 10.1176/appi.ajp.159.5.845] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors interviewed individuals treated for self-described mental health problems in the preceding year to examine patterns and predictors associated with dropping out of treatment. METHOD Subjects were drawn from respondents to community epidemiological surveys carried out in representative samples of the United States and Ontario populations. Dropouts were those who had left mental health treatment during the prior year for reasons other than symptom improvement. The surveys also assessed potential dropout correlates: sociodemographic characteristics, attitudes about mental health care, disorder type, provider type, and treatment received. RESULTS The proportion of dropouts did not significantly differ between the United States (19.2%) and Ontario (16.9%), nor did the effects of the predictors differ significantly between the two samples. Sociodemographic characteristics associated with treatment dropout included low income, young age, and, in the United States, lacking insurance coverage for mental health treatment. Patient attitudes associated with dropout included viewing mental health treatment as relatively ineffective and embarrassment about seeing a mental health provider. Respondents who received both medication and talk therapy were less likely to drop out than those who received single-modality treatments. CONCLUSIONS Mental health treatment dropout is a serious problem, especially among patients who have low income, are young, lack insurance, are offered only single-modality treatments, and have negative attitudes about mental health care. Cost-effective interventions targeting these groups are needed to increase the proportion of patients who complete an adequate course of treatment.
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Dimberg LA, Striker J, Nordanlycke-Yoo C, Nagy L, Mundt KA, Sulsky SI. Mental health insurance claims among spouses of frequent business travellers. Occup Environ Med 2002; 59:175-81. [PMID: 11886948 PMCID: PMC1763631 DOI: 10.1136/oem.59.3.175] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers. METHODS Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997-8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories. RESULTS There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (>or= four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation. CONCLUSION The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.
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Coleman PK, Reardon DC, Rue VM, Cougle J. State-funded abortions versus deliveries: a comparison of outpatient mental health claims over 4 years. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2002; 72:141-152. [PMID: 14964603 DOI: 10.1037/0002-9432.72.1.1410155] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this record-based study, rates of 1st-time outpatient mental health treatment for 4 years following an abortion or a birth among women receiving medical assistance through the state of California were compared. After controlling for preexisting psychological difficulties, age, months of eligibility, and the number of pregnancies, the rate of care was 17% higher for the abortion group (n = 14,297) in comparison with the birth group (n = 40,122). Within 90 days after the pregnancy, the abortion group had 63% more claims than the birth group, with the percentages equaling 42%, 30%, and 16% for 180 days, 1 year, and 2 years, respectively. Additional comparisons between the abortion and birth groups were conducted on the basis of claims for specific types of disorders and age.
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Rochefort DA. The Rhode Island public and the mental-health parity debate. MEDICINE AND HEALTH, RHODE ISLAND 2001; 84:365-8. [PMID: 12355664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Eisen SV, Shaul JA, Leff HS, Stringfellow V, Clarridge BR, Cleary PD. Toward a national consumer survey: evaluation of the CABHS and MHSIP instruments. J Behav Health Serv Res 2001; 28:347-69. [PMID: 11497028 DOI: 10.1007/bf02287249] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article describes a study evaluating the Consumer Assessment of Behavioral Health Survey (CABHS) and the Mental Health Statistics Improvement Program (MHSIP) surveys. The purpose of the study was to provide data that could be used to develop recommendations for an improved instrument. Subjects were 3,443 adults in six behavioral health plans. The surveys did not differ significantly in response rate or consumer burden. Both surveys reliably assessed access to treatment and aspects of appropriateness and quality. The CABHS survey reliably assessed features of the insurance plan; the MHSIP survey reliably assessed treatment outcome. Analyses of comparable items suggested which survey items had greater validity. Results are discussed in terms of consistency with earlier research using these and other consumer surveys. Implications and recommendations for survey development, quality improvement, and national policy initiatives to evaluate health plan performance are presented.
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Geyer S, Haltenhof H, Peter R. Social inequality in the utilization of in- and outpatient treatment of non-psychotic/non-organic disorders: a study with health insurance data. Soc Psychiatry Psychiatr Epidemiol 2001; 36:373-80. [PMID: 11766967 DOI: 10.1007/s001270170027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study deals with the utilization of in- and outpatient care due to non-psychotic/non-organic disorders (ICD-9 300-307: neuroses, personality disorders, sexual disturbances, alcohol and substance dependencies, drug abuse and functional disorders). Specifically, it examines whether social gradients to the detriment of individuals from lower social positions appear. This is dealt with both in terms of in- and outpatient treatment. Secondly, it examines whether the likelihood of being treated as an inpatient rather than an outpatient differs between occupational status positions. Finally, the study considers whether the hospital department a given patient is most likely to be assigned to differs between occupational status positions. METHOD Analyses were performed with records from a statutory health insurance in West Germany. The database consists of 124,917 men and women between 20 and 60 years of age. We included only subjects with employment periods, as otherwise outpatient treatment could not be assessed completely. The data had been recorded between 1987 and 1996. In total, 9129 persons had one of the above mentioned diagnoses, 6115 of them received outpatient treatment and 3014 were inpatients only. RESULTS The relative risk (RR) for outpatient diagnoses was RR=4.41 for the male unskilled/semi-skilled insured in comparison with men in the highest occupational position, the equivalent RR for women was 2.1. The respective results for inpatient treatment were RR=7.3 for men and RR=2.3 for women. In men, the relative risks were considerably reduced after cases with alcohol- and substance-related diagnoses had been excluded. For the assignment to in- and outpatient treatment, no consistent differences between individuals with different occupational positions emerged. Once diagnosed, higher-status individuals had the longest treatment periods as in- and outpatients. Only a small proportion of diagnosed subjects received medical care in psychiatric wards; this held especially for the group with higher occupational positions. CONCLUSIONS Social inequalities in the treatment of psychogenic disorders emerged for outpatients as well as for inpatients. Inpatients tended to avoid treatment in psychiatric departments, and it can be concluded that individuals holding higher positions may be more successful in their attempts to avoid stigmatization.
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Hannon MJ, Roth D. Past and present insurance coverage in a public sector community mental health population. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2001; 28:499-506. [PMID: 11804015 DOI: 10.1023/a:1012274726589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Blodgett C, Molinari C. Trends in psychiatric inpatient rates from 1991-1995 in the State of Washington: the effect of insurance type on utilization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2001; 28:393-405. [PMID: 11678070 DOI: 10.1023/a:1011118000740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined whether there have been changes in inpatient psychiatric use among publicly and privately insured patients by analyzing trends in adult psychiatric hospitalizations from 1991 through 1995 in the State of Washington. A state-wide Comprehensive Hospital Abstract Reporting System (CHARS) was used to track psychiatric hospital utilization patterns. The results show a significant growth in psychiatric hospitalizations among the publicly insured patients due to their high proportion of severe and persistent mental illness. There was a flat trend in psychiatric hospitalizations suggesting that private insurers aggressively monitor the costly use of hospitalizations for mentally ill patients.
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Sharfstein SS, Dunn L, Kent JJ. The clinical consequences of payment limitations: the experience of a private psychiatric hospital. THE PSYCHIATRIC HOSPITAL 2001; 19:63-6. [PMID: 10290271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
In the search for cost efficiency, psychiatric patients are experiencing greater restrictions on their insurance benefits. Managed psychiatric care may provide a useful alternative to arbitrary benefit limits, but may also interfere with treatment, especially if there is a disagreement between the manager and the responsible clinician. Three clinical vignettes are presented and the implications of possible premature discharge described as a first step in building a research agenda on the clinical consequences of managed psychiatric care.
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Dilonardo J, Chalk M, Mark TL, Coffey RM. Recent trends in the financing of substance abuse treatment: implications for the future. Health Serv Res 2000; 35:60-71. [PMID: 16148952 PMCID: PMC1383595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE This article focuses on the implications of a recent study of substance abuse (SA) and mental health treatment expenditures for substance abuse treatment policy. Public and private expenditures for SA treatment are estimated and compared with those for mental health and all health care in the period between 1987 and 1997. METHODS/DATA SOURCES Estimates of SA treatment expenditures were segregated from the Health Care Financing Administration's National Health Accounts across the ten-year period. Information about use, charges, and payments by provider type, payer, and diagnosis was obtained from numerous nationally representative data sets and large claims databases. Those data were used to estimate SA treatment expenditures in the general service sector. For the specialty sector two specialty facility surveys were used to estimate SA treatment expenditures. Information from the two sectors was combined and reconciled to the National Health Accounts. PRINCIPAL FINDINGS. A dramatic shift in SA expenditures away from private financing and toward public payers, as well as a shift away from hospital treatment settings, occurred between 1987 and 1997. CONCLUSIONS Evidence from this article and other research suggests that growth in SA expenditures has been contained relative to growth in all health spending. How savings from SA treatment are being invested and whether expenditure levels are appropriate to supply treatment of acceptable quality needs further study.
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Greenfield SF, Reizes JM, Muenz LR, Kopans B, Kozloff RC, Jacobs DG. Treatment for depression following the 1996 National Depression Screening Day. Am J Psychiatry 2000; 157:1867-9. [PMID: 11058488 DOI: 10.1176/appi.ajp.157.11.1867] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Characteristics of the subsequent treatment received by people who screened positive for depression in the 1996 National Depression Screening Day were investigated. METHOD A follow-up telephone survey was completed by 1,502 randomly selected participants from 2,800 sites. RESULTS Of 927 people for whom additional evaluation was recommended, 602 (64.9%) obtained evaluations and 503 (83.6%) received treatment. Of these 503, 260 (51.7%) received psychotherapy and medication, 130 (25.8%) received medication only, and 93 (18.5%) received psychotherapy only. Compared with people without health or mental health insurance, individuals with health insurance (66.7% versus 57.5%) and mental health insurance (74.6% versus 55.3%) were more likely to comply with the recommendation to obtain follow-up evaluation. CONCLUSIONS One-half of the people treated for depression received a combination of psychotherapy and medication. Lack of insurance was associated with not following the recommendation to obtain further evaluation and treatment.
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Pacula RL, Sturm R. Mental health parity legislation: much ado about nothing? Health Serv Res 2000; 35:263-75. [PMID: 10778814 PMCID: PMC1089100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To determine whether state-level parity legislation has led to an increase in utilization of mental health services. DATA SOURCES Healthcare For Communities (HCC), a multi-site nationally representative study sponsored by the Robert Wood Johnson Foundation that tracks health care system changes for mental health and substance abuse treatment. Information on state-level parity legislation was provided by state offices of the National Alliance for the Mentally Ill (NAMI); local and state market data come from the Area Resource File; information on other health mandates from Blue Cross/Blue Shield. STUDY DESIGN Two-stage regressions are used to estimate the effect of state parity legislation on use of any mental health services, use of specialty mental health services, and number of specialty visits in the past year. In the first stage, we predicted the probability that a state decides to pass parity legislation as a function of state health care market indicators and previous legislative activity. The fitted probability is used in the second stage to determine the effect of this legislation on access and utilization. PRINCIPAL FINDINGS State parity legislation is not associated with a significant increase in any of our measures of mental health services utilization. These results are robust to various specifications of the models. CONCLUSIONS Those states that are able to pass parity legislation do not experience significant increases in the utilization of mental health services. This may be due in part to a loss of coverage for those people most at risk for mental health disorders. The results could be very different, however, if strong federal legislation were passed.
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McAlpine DD, Mechanic D. Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk. Health Serv Res 2000; 35:277-92. [PMID: 10778815 PMCID: PMC1089101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To examine the sociodemographic, need, risk, and insurance characteristics of persons with severe mental illness and the importance of these characteristics for predicting specialty mental health utilization among this group. DATA SOURCE The Healthcare for Communities survey, a national study that tracks alcohol, drug, and mental health services utilization. Data come from a telephone survey of adults from 60 communities across the United States, and from a supplemental geographically dispersed sample. STUDY DESIGN Respondents were categorized as having a severe mental disorder, other mental disorder, or no measured mental disorder. Differences among groups in sociodemographics (gender, marital status, race, education, and income), insurance coverage, need for mental health care (symptoms and perceived need), and risk indicators (suicide ideation, criminal involvement, and aggressive behavior) are examined. Measures of service use for mental health care include emergency room, inpatient, and specialty outpatient care. The importance of sociodemographics, need, insurance status, and risk indicators for specialty mental health care utilization are examined through logistic regression. PRINCIPAL FINDINGS The severely mentally ill in this study are disproportionately African American, unmarried, male, less educated, and have lower family incomes than those with other disorders and those with no measured mental disorders. In a 12-month period almost three-fifths of persons with severe mental illness did not receive specialty mental health care. One in five persons with severe mental illness are uninsured, and Medicare or Medicaid insures 37 percent. Persons covered by these public programs are over six times more likely to have access to specialty care than the uninsured are. Involvement in the criminal justice system also increases the probability that a person will receive care by a factor of about four, independent of level of need. The average number of outpatient visits for specialty care varies little across type of disorder, and the median number of visits (ten) is equivalent for those with a severe mental illness and those with other disorders. CONCLUSIONS Persons with severe mental illness have a high level of economic and social disadvantage. Barriers to care, including lack of insurance, are substantial and many do not receive specialty care. Public insurance programs are the major points of leverage for improving access, and policy interventions should be targeted to these programs. Problems of adequate care for the severely mentally ill may be exacerbated by the managed care trend to reductions in intensity of treatment.
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Leslie DL, Rosenheck R. Changes in inpatient mental health utilization and costs in a privately insured population, 1993 to 1995. Med Care 1999; 37:457-68. [PMID: 10335748 DOI: 10.1097/00005650-199905000-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Concerns over rising health care costs have led to pressure on health care providers to reduce inpatient costs. METHODS Inpatient claims data were analyzed for adult users of mental health services (n = 45,579) from a national sample of over 3.8 million privately insured individuals between 1993 and 1995 from the MarketScan database. Costs and annual hospital days per treated patient were compared across diagnostic groups and plan types. RESULTS Inpatient mental health costs fell 30.5% over the period, driven primarily by decreases in the number of hospital days per treated patient per year (-20.0%), with smaller changes in the proportion of enrollees who received care (-0.2%), and per diem costs (-13.1%). Patients whose primary diagnosis was mild/moderate depression saw the largest decrease in costs per treated patient (44.5%), and those diagnosed with schizophrenia experienced the smallest decrease (23.5%). There was no evidence of substitution of medical for psychiatric care. CONCLUSIONS Inpatient cost reductions have been substantial and are primarily caused by reductions in the number of inpatient mental health treatment days per treated patient. Further research is needed to evaluate the impact of these changes on outcome, quality of care, and patient satisfaction.
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Chabra A, Chávez GF, Harris ES, Shah R. Hospitalization for mental illness in adolescents: risk groups and impact on the health care system. J Adolesc Health 1999; 24:349-56. [PMID: 10331841 DOI: 10.1016/s1054-139x(98)00116-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the extent and cost of hospitalizations for mental illness among adolescents and to identify differences in acute care hospital use by gender and between racial/ethnic groups. METHODS Analysis of discharge data for adolescents, 10 to 19 years of age (n = 27,595), with a principal diagnosis of mental illness from acute care hospitals in California in 1994. Relative risks (RRs) were calculated by race/ethnicity and gender and stratified by race/ethnicity and payment source. RESULTS Mental illness accounted for 14.8% of hospitalizations in this age group; the mean length of stay was 10.9 days. Total charges exceeded $300 million. Overall, adolescent boys had a slightly lower risk of hospitalization for mental illness than did adolescent girls (RR = 0.90, 95% confidence interval [CI] = 0.87, 0.92) but a higher risk for certain diagnoses. Overall, nonwhite adolescents had a lower risk of hospitalization for mental illness than did white adolescents: African-Americans (RR = 0.77, 95% CI = 0.74, 0.81), Latinos (RR = 0.32, 95% CI = 0.31, 0.33), and Asians/others (RR = 0.27, 95% CI = 0.26, 0.29). These differences remained significant after stratification by payment source. CONCLUSIONS The risk of hospitalization for mental illness among adolescents varies by specific mental illness and by race/ethnicity. In light of the significant human and financial costs associated with hospitalization for mental illness, further research into the determinants of illness and the options for care is warranted.
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