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Lu W, Lopez-Castro T, Vu T. Population-based examination of substance use disorders and treatment use among US young adults in the National Survey on Drug Use and Health, 2011-2019. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100181. [PMID: 37593411 PMCID: PMC10430156 DOI: 10.1016/j.dadr.2023.100181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
Background Compared with adults of other age groups, young adults are more likely to have substance use disorders (SUDs) but less likely to receive treatment. Untreated SUDs can lead to lethal consequences, particularly deaths related to drug overdose. Objectives This study aimed to examine trends and sociodemographic differences in the prevalence and treatment use of SUDs among US young adults aged 18 to 25 in the National Survey on Drug Use and Health 2011-2019. Methods Bivariable logistic regression analyses were conducted to examine annual changes in the prevalence and treatment use of SUDs, and multivariable logistic regression was used to examine sociodemographic differences in SUD prevalence and treatment use in the pooled sample of young adults from 2011 to 2019. Results From 2011 to 2019, the overall SUD prevalence increased significantly from 5.4% to 6.2%. Cannabis use disorder was the most common SUD annually. Groups with lower prevalence of SUDs included females, young adults aged 22-25, and Hispanic, Black, and Asian participants. Across the survey years, the prevalence of treatment use fluctuated insignificantly between 10.9% and 16.9% among young adults with SUDs, and most young adults received SUD treatment in self-help groups and residential and outpatient rehabilitation facilities. Compared to White participants, treatment use was lower in Hispanic, Black, Asian participants, as well as young adults of two or more races. Young adults covered by Medicaid/CHIP were more likely to use treatment. Conclusions This study revealed an alarming level of unmet treatment need and significant disparities in treatment use among young adults with SUDs. To reduce barriers to treatment utilization, more coordinated efforts that leverage policy and structural changes alongside innovations to engage young adults with SUD care are needed.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, USA
| | | | - Thinh Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, USA
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McGINTY BETH. The Future of Public Mental Health: Challenges and Opportunities. Milbank Q 2023; 101:532-551. [PMID: 37096616 PMCID: PMC10126977 DOI: 10.1111/1468-0009.12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/30/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Social policies such as policies advancing universal childcare to expand Medicaid coverage of home- and community-based care for seniors and people with disabilities and for universal preschool are the types of policies needed to address social determinants of poor mental health. Population-based global budgeting approaches like accountable care and total cost of care models have the potential to improve population mental health by incentivizing health systems to control costs while simultaneously improving outcomes for the populations they serve. Policies expanding reimbursement for services delivered by peer support specialists are needed. People with lived experience of mental illness are uniquely well suited to helping their peers navigate treatment and other support services.
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Penev T, Zhao S, Lee JL, Chen CE, Metcalfe L, Ozminkowski RJ. The Impact of a Workforce Mental Health Program on Employer Medical Plan Spend: An Application of Cost Efficiency Measurement for Mental Health Care. Popul Health Manag 2023; 26:60-71. [PMID: 36799934 PMCID: PMC9969895 DOI: 10.1089/pop.2022.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Mental health issues often result in significant impairment and financial challenges, both at home and in the workplace. Solutions vary widely in their usage and cost-effectiveness. This study presents an analysis of medical and prescription drug spending and utilization data for the employees of 4 companies who were eligible for an evidence-based workforce mental health program (WMHP). A variation of coarsened exact matching paired WMHP users to nonusers, based on demographics, location, and medical factors. Individuals included 2791 pairs of members whose medical claims were incurred in 2018 and 3883 pairs with claims in 2019. Using a cost efficiency measurement process, mean cost and utilization per person per year (PPPY) were compared. WMHP users had lower medical (-$2295 in 2018; -$2304 in 2019) and prescription drug spending (-$295 in 2018; -$312 in 2019). Over half of the cost reduction (-$1252 in 2018; -$1211 in 2019) resulted from shifting therapy services from the medical benefit to WMHP. WMHP users attended about 12 sessions PPPY, whereas the comparison group of nonusers attended about 7 mental health office visits PPPY under the medical benefit. WMHP users had more mental health-related visits in both years, but had fewer visits on the medical plan, and fewer emergency department visits for mental health than comparison group members. These results provide evidence that high-quality, evidence-based mental health services can reduce total expenditures and change utilization patterns. Evidence-based WMHP may represent a prudent investment for employers in providing mental health care to employees.
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Affiliation(s)
- Todor Penev
- Health Solutions, Aon plc, Atlanta, Georgia, USA
| | - Shelley Zhao
- Health Solutions, Aon plc, Portland, Oregon, USA
| | - Jennifer L Lee
- Lyra Health, Burlingame, California, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
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Douglas MD, Bent Weber S, Bass C, Li C, Gaglioti AH, Benevides T, Heboyan V. Creation of a Longitudinal Legal Data Set to Support Legal Epidemiology Studies of Mental Health Insurance Legislation. Psychiatr Serv 2022; 73:265-270. [PMID: 34320828 DOI: 10.1176/appi.ps.202100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article describes policy surveillance methodology used to track changes in the comprehensiveness of state mental health insurance laws over 23 years, resulting in a data set that supports legal epidemiology studies measuring effects of these laws on mental health outcomes. METHODS Structured policy surveillance methods, including a coding protocol, blind coding of laws in 10% of states, and consensus meetings, were used to track changes in state laws from 1997 through 2019-2020. The legal database Westlaw was used to identify relevant statutes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definitions of mental health conditions, and enforcement-compliance. Points (range 0-7) were assigned to reflect the laws' comprehensiveness and aid interpretation of changes over time. RESULTS The search resulted in 147 coding time periods across 51 jurisdictions (50 states, District of Columbia). Intercoder consensus rates increased from 89% to 100% in the final round of blinded duplicate coding. Since 1997, average comprehensiveness scores increased from 1.31 to 3.82. In 1997, 41% of jurisdictions had a parity law, 28% mandated coverage, 31% defined mental health conditions, and 8% required state agency enforcement. In 2019-2020, 94% of jurisdictions had a parity law, 63% mandated coverage, 75% defined mental health conditions, and 29% required state enforcement efforts. CONCLUSIONS Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.
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Affiliation(s)
- Megan D Douglas
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Samantha Bent Weber
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Claire Bass
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Chaohua Li
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Anne H Gaglioti
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Teal Benevides
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Vahé Heboyan
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
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Tambling RR, D’Aniello C, Russell BS. Health Insurance Literacy among Caregivers of Substance Using Young Adults. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1927926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rachel R. Tambling
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carissa D’Aniello
- Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Beth S. Russell
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Yingling ME, Ruther MH, Dubuque EM, Bell BA. Impact of County Sociodemographic Factors and State Policy on Geographic Access to Behavior Analysts Among Children with Autism Spectrum Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:1105-1114. [PMID: 33620610 PMCID: PMC7900801 DOI: 10.1007/s10488-021-01120-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
To examine the relationship between geographic access to Board Certified Behavior Analysts (BCBAs) among children with autism spectrum disorder (ASD) and county sociodemographic factors and state policy, we integrated publicly available data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. The study sample included U.S. counties and county equivalents (e.g., parishes, independent cities) in 49 states and D.C. (N = 3040). Using GIS software, we assigned BCBAs to counties based on their residence, allocated children via school districts to counties, and generated per-capita children with ASD/BCBA ratios. We distributed counties into five categories based on these ratios: no BCBAs (reference), ≥ 31, 21–30, 11–20, > 0–10. We used a generalized logit model to conduct analyses. Highly affluent and urban counties had the highest access to BCBAs with odds ratio estimates for affluence ranging from 2.26 to 5.26. County-level poverty was positively associated with access, yet this relationship was moderated by urbanicity. Race-ethnicity and healthcare insurance coverage were negatively related to access. Other variables were not significant. Targeting non-urban and less affluent counties for provider recruitment and maintenance could most improve access to BCBAs. In addition to strategies specific to BCBAs for improving geographic access, traditional strategies used for other healthcare providers could be useful.
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Affiliation(s)
- Marissa E Yingling
- Kent School of Social Work, University of Louisville, 2217 S 3rd St, Oppenhimer Hall, Louisville, KY, 40208, USA.
| | - Matthew H Ruther
- College of Arts and Sciences, Department of Urban and Public Affairs, University of Louisville, Louisville, KY, USA
| | - Erick M Dubuque
- College of Education and Human Development, Department of Special Education, Early Childhood & Prevention Science, University of Louisville, Louisville, KY, USA
| | - Bethany A Bell
- College of Social Work, University of South Carolina, Columbia, SC, USA
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Tambling RR, Russell B, D'Aniello C. Where is the Family in Young Adult Substance Use Treatment? The Case for Systemic Family Therapy for Young Adults with Substance Use Disorders. Int J Ment Health Addict 2021; 20:1659-1670. [PMID: 33424512 PMCID: PMC7781401 DOI: 10.1007/s11469-020-00471-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 01/31/2023] Open
Abstract
Despite the prevalence of SUDs, many individuals remain untreated (Grant et al., JAMA Psychiatry, 73(1), 39-45, 2016). Substance use disorders (SUDs) in young adults present unique challenges and stressors to parents of these individuals (D’Aniello et al., American Journal of Family Therapy, 2020; Kaur et al., International Journal of Community Medicine and Public Health, 5(6), 2380-2383, 2018; Shumway et al., Alcoholism Treatment Quarterly, 37(1), 75-98, 2019). Parents and caregivers often facilitate their children’s care and provide pragmatic and emotional support to their children; this high level of care is challenging to maintain, as with any chronic, relapsing condition. In the case of SUDs, the challenges caregivers face may be exacerbated by the stigma and the blame associated with parents in the development and maintenance of children’s SUDs, and the strains that come with navigating barriers related to accessing treatment in the USA. Estimates suggest that healthcare spending for substance use treatment is relatively low and few utilize therapeutic family treatment. This disconnect between widespread SUD prevalence, and service underutilization, indicates that families who need treatment are not accessing it. The present paper synthesizes the extant literature on the role of family members in SUD treatment, as families are a primary context of care for their children’s treatment across many chronic, relapsing conditions. Finally, we identify the utility of family therapy in addressing family member’s unique needs related to their loved one with a SUD, in the family and in a treatment context.
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Affiliation(s)
- Rachel R Tambling
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., U-1058, Storrs, CT 06269-1058 USA
| | - Beth Russell
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., U-1058, Storrs, CT 06269-1058 USA
| | - Carissa D'Aniello
- Community, Family, and Addiction Services, Texas Tech University, 2500 Broadway, Lubbock, TX 79409 USA
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Pelech D, Hayford T. Medicare Advantage And Commercial Prices For Mental Health Services. Health Aff (Millwood) 2020; 38:262-267. [PMID: 30715986 DOI: 10.1377/hlthaff.2018.05226] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2014, insurers paid an average of 13-14 percent less for in-network mental health services in their commercial and Medicare Advantage plans than fee-for-service Medicare paid for identical services-despite paying up to 12 percent more than Medicare when the same services were provided by other physician specialties. However, patients went out of network more frequently for mental health services than for comparison services, which increased their average cost-sharing payments.
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Affiliation(s)
- Daria Pelech
- Daria Pelech ( ) is a principal analyst in the Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office, in Washington, D.C
| | - Tamara Hayford
- Tamara Hayford is a principal analyst in the Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office
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Hoffmann JA, Grupp-Phelan J. Advocacy Opportunities for Pediatricians and Emergency Physicians to Prevent Youth Suicide. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity. Med Care 2020; 58:101-107. [PMID: 31688556 DOI: 10.1097/mlr.0000000000001242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid. OBJECTIVES To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity). RESEARCH DESIGN Observational study using an interrupted time series design. SUBJECTS 2002-2013 data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for all SUD treatment facilities was combined with state-level characteristics. MEASURES Primary outcome is whether a SUD treatment facility reported accepting Medicaid insurance. RESULTS Implementation of MHPAEA was associated with a 4.6 percentage point increase in the probability of an SUD treatment facility accepting Medicaid (P<0.001), independent of facility and state characteristics, time trends, and key characteristics of state Medicaid programs. CONCLUSIONS After parity, more SUD treatment facilities accepted Medicaid payments, which may ultimately increase access to care for individuals with SUD. The findings underscore how parity laws are critical policy tools for creating contexts that enable historically vulnerable and underserved populations with SUD to access needed health care.
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Fuhrer R, Keyes KM. Population Mental Health in the 21st Century: Aspirations and Experiences. Am J Public Health 2020; 109:S150-S151. [PMID: 31242004 DOI: 10.2105/ajph.2019.305187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rebecca Fuhrer
- Rebecca Fuhrer is with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Katherine M. Keyes is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Rebecca Fuhrer and Katherine M. Keyes are also Guest Editors for this supplement issue
| | - Katherine M Keyes
- Rebecca Fuhrer is with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Katherine M. Keyes is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Rebecca Fuhrer and Katherine M. Keyes are also Guest Editors for this supplement issue
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Factors Associated with Psychiatrist Opt-out from US Medicare: an Observational Study. J Gen Intern Med 2019; 34:2460-2466. [PMID: 31420824 PMCID: PMC6848419 DOI: 10.1007/s11606-019-05246-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/11/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Concerns exist about availability and access to psychiatric services in the USA. For Medicare beneficiaries, one impediment to psychiatric services is the extent to which psychiatrists have opted out of the Medicare program. OBJECTIVE This study describes geographic variation in rates that psychiatrists opt out of Medicare, and assesses physician-level and geographic-level predictors of opt-out. DESIGN Retrospective cross-sectional analysis of data describing psychiatrists' opt-out status as of March 2017 linked to data on psychiatrist location, psychiatrist characteristics (obtained from a comprehensive US physician database), and market area-level characteristics. PARTICIPANTS 27,838 psychiatrists in the USA MAIN MEASURES: Whether a psychiatrist had opted out of Medicare as of March 2017. KEY RESULTS Overall, 7.0% of psychiatrists (1940/27,838) opted out of Medicare as of March 2017. Opt-out rates varied substantially across states and within states. Physician-level factors independently associated with opt-out included: older age (psychiatrists > 65 years were 2.6 percentage points more likely to opt vs. psychiatrists < 35 years old, p = 0.03), greater years of experience, female gender (female psychiatrists were 2.6 percentage points more likely to opt out than male psychiatrists, p < 0.001), graduation from a top-20 ranked medical school (1.7 percentage points more likely to opt out of Medicare, p < 0.001), and domestic medical graduate (domestic graduates were 7.3 percentage points more likely to opt out of Medicare vs. foreign graduates, p < 0.001). Adjusting for other individual- and geographic-level factors, psychiatrists who practiced in areas with more psychiatrists per Medicare beneficiary were less likely to opt out (p < 0.001). CONCLUSIONS The overall likelihood that psychiatrists opt out of Medicare is significant and varies considerably across regions and by characteristics of psychiatrists.
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Mulia N, Lui CK, Ye Y, Subbaraman MS, Kerr WC, Greenfield TK. U.S. alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference? J Subst Abuse Treat 2019; 106:113-121. [PMID: 31451310 DOI: 10.1016/j.jsat.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/11/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups. METHODS We analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups. RESULTS While we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws. CONCLUSION The MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Meenakshi S Subbaraman
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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Mulvaney-Day N, Gibbons BJ, Alikhan S, Karakus M. Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. Am J Public Health 2019; 109:S190-S196. [PMID: 31242013 DOI: 10.2105/ajph.2019.305023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the impact of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) on mental and substance use disorder services in the private, large group employer-sponsored insurance market in the United States. Methods. We analyzed data from the IBM MarketScan Commercial Database from January 2005 through September 2015 by using population-level interrupted time series regressions to determine whether parity implementation was associated with utilization and spending outcomes. Results. MHPAEA had significant positive associations with utilization of mental and substance use disorder outpatient services. A spending decomposition analysis indicated that increases in utilization were the primary drivers of increases in spending associated with MHPAEA. Analyses of opioid use disorder and nonopioid substance use disorder services found that associations with utilization and spending were not attributable only to increases in treatment of opioid use disorder. Conclusions. MHPAEA is positively associated with utilization of outpatient mental and substance use disorder services for Americans covered by large group employer-sponsored insurance. Public Health Implications. These trends continued over the 5-year post-MHPAEA period, underscoring the long-term relationship between this policy change and utilization of behavioral health services.
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Affiliation(s)
- Norah Mulvaney-Day
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Brent J Gibbons
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Shums Alikhan
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Mustafa Karakus
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
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Drake C, Busch SH, Golberstein E. The Effects of Federal Parity on Mental Health Services Use and Spending: Evidence From the Medical Expenditure Panel Survey. Psychiatr Serv 2019; 70:287-293. [PMID: 30691381 DOI: 10.1176/appi.ps.201800313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the effects of the federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 on the use of outpatient and clinic-based mental health services and spending on those services. METHODS Data came from the 2005-2013 Medical Expenditure Panel Survey. The analytic sample included adults ages 26-64 who were continuously enrolled in employer-sponsored insurance for a calendar year (N=66,602 person-year observations). A difference-in-differences study design was used to compare changes in outcomes before and after implementation of the MHPAEA between people whose insurance plan was or was not affected by the law. RESULTS The federal parity law was not significantly associated with changes in the likelihood of using mental health services, the amount of mental health services used, or total or out of-pocket spending for mental health services. The law was marginally significantly associated with a shift toward more use of mental health specialty services rather than primary care services among individuals who used ambulatory mental health care. CONCLUSIONS Consistent with other research using different study designs and data, this study found that the MHPAEA had at most small effects on patterns of mental health services use and spending through 2013. Understanding whether these effects were small because most employer-sponsored plans were already parity compliant or because plans were noncompliant with the law has major implications for mental health policy and parity enforcement.
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Affiliation(s)
- Coleman Drake
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein)
| | - Susan H Busch
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein)
| | - Ezra Golberstein
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein)
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Cowell AJ, Prakash S, Jones E, Barnosky A, Wedehase B. Behavioral Health Coverage In The Individual Market Increased After ACA Parity Requirements. Health Aff (Millwood) 2018; 37:1153-1159. [PMID: 29985686 DOI: 10.1377/hlthaff.2017.1517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans in 2014 (after parity provisions took effect) and sixty comparison plans in 2013 (the year before parity provisions took effect) to understand the degree to which coverage for mental health and substance use care improved relative to medical/surgical benefits. The results suggest that plan issuers did what the provisions required them to do. Although in 2013 a lower proportion of plans covered mental health or substance use care, compared to medical/surgical care, in 2014 the proportions were the same. If essential health benefit requirements were to be removed and mental health and substance use coverage becomes similar to that in 2013, as many as 20 percent of the plans in our sample would not cover these conditions. To determine whether increases in behavioral health coverage will result in improved access to behavioral health services requires complementary data on the size of provider networks and use of services.
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Affiliation(s)
- Alexander J Cowell
- Alexander J. Cowell ( ) is a senior research economist at RTI International in Research Triangle Park, North Carolina
| | - Shivaani Prakash
- Shivaani Prakash is a public health research analyst at RTI International in San Francisco, California
| | - Emily Jones
- Emily Jones is a professorial lecturer in the Department of Health Policy and Management, George Washington University, in Washington, D.C
| | - Alan Barnosky
- Alan Barnosky is an economist at RTI International in Research Triangle Park
| | - Brendan Wedehase
- Brendan Wedehase is an economist at RTI International in Research Triangle Park
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