1
|
Ortega A. The highs and the lows: Recreational marijuana laws and mental health treatment. HEALTH ECONOMICS 2023; 32:2173-2191. [PMID: 37391873 DOI: 10.1002/hec.4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
Recreational marijuana laws (RMLs) continue to grow in popularity, but the effects on mental health treatment are unclear. This paper uses an event-study within a difference-in-differences framework to study the short-run impact of state RMLs on admissions into mental health treatment facilities. The results indicate that shortly after a state adopts an RML, they experience a decrease in the average number of mental health treatment admissions. The findings are driven by white, Black, and Medicaid-funded admissions and are consistent for both male and female admissions. The results are robust to alternative specifications and sensitivity analysis.
Collapse
|
2
|
Ortega A. Medicaid Expansion and mental health treatment: Evidence from the Affordable Care Act. HEALTH ECONOMICS 2023; 32:755-806. [PMID: 36480355 DOI: 10.1002/hec.4633] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
This study uses a difference-in-differences design within an event-study framework to examine how state decisions to expand Medicaid following the passage of the Affordable Care Act (ACA) affected mental health treatment. The findings suggest that expansion states experienced increased admissions to mental health treatment facilities and Medicaid-reimbursed prescriptions for medications used to treat common forms of mental illness. The results also indicate an increase in admissions with trauma, anxiety, conduct, and depression disorders. There is also suggestive evidence of an increase in the number of mental health treatment facilities accepting Medicaid as a form of payment. Lastly, as with previous studies, I find weak evidence of a decrease in suicides in Medicaid expansion states. These findings highlight the vital role of the ACA in providing access to mental health treatment for low-income Americans.
Collapse
Affiliation(s)
- Alberto Ortega
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana, USA
| |
Collapse
|
3
|
Smith-East M, Conner NE, Neff DF. Access to Mental Healthcare in the 21st Century: An Evolutionary Concept Analysis. J Am Psychiatr Nurses Assoc 2022; 28:203-215. [PMID: 33978509 DOI: 10.1177/10783903211011672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND One of the most important aspects of receiving medical care is access to that care. For people with mental illness who have greater healthcare needs and are at risk for poor health outcomes, reduced access to care constitutes a crisis. While the COVID-19 (coronavirus disease 2019) pandemic continues to affect the United States, specifying what it means to have access to mental healthcare is more critical than ever. AIMS The aims of this concept analysis are to review definitions and descriptions of access to mental healthcare in the literature and to synthesize the relevance of these findings to inform future research, theory development, policy, and practice. METHODS The concept of access to mental healthcare was analyzed using Rodgers's evolutionary concept analysis method. CINAHL, PsycINFO, and MEDLINE were queried for peer-reviewed articles about access to mental healthcare published from January 2010 to April 2020 (n = 72). Data were reviewed for concept antecedents, attributes, consequences, surrogate, and related terms. RESULTS Five models of access to mental healthcare were identified, with several antecedents and consequences: utilization, economic loss/gain, incarceration, and patient/provider satisfaction. Cross-sectional and predictive studies highlighted three interrelated attributes: clinical management, healthcare delivery, and connectedness. CONCLUSIONS The concept of access to mental healthcare is often used stagnantly across disciplines to create health policies, yet the concept is transformative. Future research requires up-to-date operational definitions of access to mental healthcare to target interdisciplinary approaches.
Collapse
Affiliation(s)
- Marie Smith-East
- Marie Smith-East, PhD, DNP, PMHNP-BC, EMT-B, University of Central Florida, Orlando, FL, USA
| | - Norma E Conner
- Norma E. Conner, PhD, RN, FNAP, University of Central Florida, Orlando, FL, USA
| | - Donna Felber Neff
- Donna Felber Neff, PhD, RN, FNAP, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
4
|
Mojtabai R, Mauro C, Wall MM, Barry CL, Olfson M. Private health insurance coverage of drug use disorder treatment: 2005-2018. PLoS One 2020; 15:e0240298. [PMID: 33035265 PMCID: PMC7546457 DOI: 10.1371/journal.pone.0240298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/23/2020] [Indexed: 11/19/2022] Open
Abstract
Many privately insured adults with drug use disorders in the United States do not have health care coverage for drug use treatment. The Affordable Care Act sought to redress this gap by including substance use treatments as essential health benefits under new plans offered. This study used data from 11,732 privately insured adult participants of the 2005-2018 National Survey on Drug Use and Health with drug use disorders to examine trends in drug use treatment coverage and the association of coverage with receiving treatment. 37.6% of the participants with drug use disorders did not know whether their plan covered drug use treatment, with little change over time. Among those who knew, coverage increased modestly between the 2005-2013 and 2014-2018 periods (73.5% vs. 77.5%, respectively, p = .015). Coverage was associated with receiving drug use treatment (adjusted odds ratio = 2.09, 95% confidence interval = 1.61-2.72, p < .001). However, even among participants with coverage, only 13.4% received treatment. Broader coverage of drug use treatment could potentially improve treatment rates.
Collapse
Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States of America
| | - Christine Mauro
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Melanie M. Wall
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Colleen L. Barry
- Department of Health Policy and Management and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| |
Collapse
|
5
|
Satre DD, Palzes VA, Young-Wolff KC, Parthasarathy S, Weisner C, Guydish J, Campbell CI. Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. J Subst Abuse Treat 2020; 118:108097. [PMID: 32972648 DOI: 10.1016/j.jsat.2020.108097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/24/2020] [Accepted: 07/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of SUD treatment and other healthcare services. Understanding these relationships can inform future healthcare policy. METHODS We conducted a longitudinal analysis of patients with SUDs newly enrolled in the Kaiser Permanente Northern California health system in 2014 (N = 6957). Analyses examined the likelihood of service utilization (primary care, specialty SUD treatment, psychiatry, inpatient, and emergency department [ED]) over three years after SUD diagnosis, and associations with enrollment mechanisms (ACA Exchange vs. other), deductibles (none, $1-$999 [low] and ≥$1000 [high]), membership duration, psychiatric comorbidity, and demographic characteristics. We also evaluated whether the enrollment mechanism moderated the associations between deductible limits and utilization likelihood. RESULTS Service utilization was highest in the 6 months after SUD diagnosis, decreased in the following 6 months, and remained stable in years 2-3. Relative to patients with no deductible, those with a high deductible had lower odds of using all health services except SUD treatment; associations with primary care and psychiatry were strongly negative among Exchange enrollees. Among non-Exchange enrollees, patients with deductibles were more likely than those without deductibles to receive SUD treatment. Exchange enrollment compared to other mechanisms was associated with less ED use. Psychiatric comorbidity was associated with greater use of all services. Nonwhite patients were less likely to initiate SUD and psychiatry treatment. CONCLUSIONS Higher deductibles generally were associated with use of fewer health services, especially in combination with enrollment through the Exchange. The role of insurance factors, psychiatric comorbidity and race/ethnicity in health services for people with SUDs are important to consider as health policy evolves.
Collapse
Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Kelly C Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Constance Weisner
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, San Francisco, CA 94118, United States of America
| | - Cynthia I Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| |
Collapse
|
6
|
Nelson KL, Purtle J. Factors associated with state legislators' support for opioid use disorder parity laws. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102792. [PMID: 32540516 PMCID: PMC7483853 DOI: 10.1016/j.drugpo.2020.102792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States, state behavioral health parity laws play a crucial role in ensuring equitable insurance coverage and access to substance use disorder treatment and services for people that need them. State legislators have the exclusive authority to adopt these laws. The purpose of this study was to identify legislator beliefs independently associated with "strong support" for opioid use disorder (OUD) parity. METHODS Data were from a 2017 cross-sectional, state-stratified, multi-modal survey of state legislators (N = 475). The dependent variable was "strong support" for OUD parity. Primary independent variables were beliefs about state parity laws. Bivariate analyses and mixed effects logistic regression were conducted. RESULTS Legislators who "strongly supported" OUD parity were significantly more likely than legislators who did not "strongly support" OUD parity to be female (64.1% vs. 46.5%, p<.001) , Democrat (76.2% vs. 29.3%, p<.001), and have liberal, compared to conservative, ideology (85.6% vs. 27.1%, p<.001). After adjusting for legislator demographics and state-level covariates, beliefs such as agreeing that state parity laws do not increase health insurance premium costs (aOR=6.77, p<.01) and that substance use disorder treatments can be effective (aOR=5.00, p<.001) remained associated with "strong support" for OUD parity. These state legislators' beliefs were more strongly associated with "strong support" for OUD parity than political party, ideology, and other demographic and state-level characteristics. CONCLUSIONS Dissemination materials and communication strategies to cultivate support for OUD parity laws among state legislators should focus on the fiscal impacts of parity laws and the effectiveness of substance use disorder treatments.
Collapse
Affiliation(s)
- Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States; Urban Health Collaborative, Drexel University, Philadelphia, PA, United States.
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| |
Collapse
|
7
|
Jones EB, Staab EM, Wan W, Quinn MT, Schaefer C, Gedeon S, Campbell A, Chin MH, Laiteerapong N. Addiction Treatment Capacity in Health Centers: The Role of Medicaid Reimbursement and Targeted Grant Funding. Psychiatr Serv 2020; 71:684-690. [PMID: 32438889 DOI: 10.1176/appi.ps.201900409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Expanding access to addiction screening and treatment in primary care, particularly in underserved communities, is a key part of the fight against the opioid epidemic. This study explored correlates of addiction treatment capacity in federally qualified health centers participating in the Midwest Clinicians' Network (MWCN). METHODS Two surveys were fielded to 132 MWCN health centers: the Health Center Survey and the Behavioral Health and Diabetes Provider Survey. A total of 77 centers and 515 primary care clinicians, respectively, responded to the surveys. Data were combined with data from the 2016 Uniform Data System and information about receipt of targeted Health Resources and Services Administration (HRSA) grant funding for addiction treatment capacity. Multivariable models examined associations between Medicaid reimbursement for addiction services, HRSA targeted grant funding, and different types of on-site addiction treatment capacity: psychiatrist and certified addiction counselor staffing, addiction counseling services, and medication-assisted treatment (MAT) for opioid addiction. RESULTS Health centers that received Medicaid behavioral health reimbursement were five times as likely as those that did not to offer addiction counseling and to employ certified addiction counselors. Health centers that received targeted HRSA funding for addiction services were more than 20 times as likely as those that did not to provide MAT and more than three times as likely to employ psychiatrists. Training needs and privacy protections on data related to addiction treatment were cited as barriers to building addiction treatment capacity. CONCLUSIONS Medicaid funding and targeted grant funding were associated with addiction treatment capacity in health centers.
Collapse
Affiliation(s)
- Emily B Jones
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Erin M Staab
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Wen Wan
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Michael T Quinn
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Cynthia Schaefer
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Stacey Gedeon
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Amanda Campbell
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Marshall H Chin
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Neda Laiteerapong
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| |
Collapse
|
8
|
Pellegrini LC, Geissler KH. Disability, Federal Disability Benefits, and Health Care Access After the Affordable Care Act. JOURNAL OF DISABILITY POLICY STUDIES 2020. [DOI: 10.1177/1044207320919959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited research considers whether differences in health care access and utilization exist for individuals with a disability with and without receipt of federal disability benefits in the Affordable Care Act (ACA) era. National Health Interview Survey (NHIS) data (2014–2016) are used to estimate the relationship between federal disability benefit receipt and health care access and utilization for individuals with a disability, controlling for disability benefit application, and predisposing, enabling, and need characteristics. Study results show that individuals with a disability receiving federal disability benefits have increased odds of seeing any provider (odds ratio [OR]: 1.50; 95% confidence interval [CI] = [1.12, 2.01]) and decreased odds of worrying about the costs of health care (OR: 0.68; 95% CI = [0.57, 0.80]) and delaying needed medical care due to costs (OR: 0.50; 95% CI = [0.42, 0.61]) versus nonrecipients with a disability. Findings highlight the continued importance to address disabled nonrecipients’ health care access and utilization barriers in the post-ACA period.
Collapse
|