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Golberstein E, Busch SH. Mental Health Insurance Parity and Provider Wages. J Ment Health Policy Econ 2017; 20:75-82. [PMID: 28604354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Policymakers frequently mandate that employers or insurers provide insurance benefits deemed to be critical to individuals' well-being. However, in the presence of private market imperfections, mandates that increase demand for a service can lead to price increases for that service, without necessarily affecting the quantity being supplied. We test this idea empirically by looking at mental health parity mandates. OBJECTIVE This study evaluated whether implementation of parity laws was associated with changes in mental health provider wages. METHOD Quasi-experimental analysis of average wages by state and year for six mental health care-related occupations were considered: Clinical, Counseling, and School Psychologists; Substance Abuse and Behavioral Disorder Counselors; Marriage and Family Therapists; Mental Health Counselors; Mental Health and Substance Abuse Social Workers; and Psychiatrists. Data from 1999-2013 were used to estimate the association between the implementation of state mental health parity laws and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and average mental health provider wages. RESULTS Mental health parity laws were associated with a significant increase in mental health care provider wages controlling for changes in mental health provider wages in states not exposed to parity (3.5 percent [95% CI: 0.3%, 6.6%]; p<.05). DISCUSSION Mental health parity laws were associated with statistically significant but modest increases in mental health provider wages. IMPLICATIONS Health insurance benefit expansions may lead to increased prices for health services when the private market that supplies the service is imperfect or constrained. In the context of mental health parity, this work suggests that part of the value of expanding insurance benefits for mental health coverage was captured by providers. Given historically low wage levels of mental health providers, this increase may be a first step in bringing mental health provider wages in line with parallel health professions, potentially reducing turnover rates and improving treatment quality.
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Affiliation(s)
- Ezra Golberstein
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729. Minneapolis, MN 55455, USA,
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Sareen J, Wang Y, Mota N, Henriksen CA, Bolton J, Lix LM, Mojtabai R, Bienvenu OJ, Crum RM, Afifi TO. Baseline Insurance Status and Risk of Common Mental Disorders: A Propensity-Based Analysis of a Longitudinal U.S. Sample. Psychiatr Serv 2016; 67:62-70. [PMID: 26567928 DOI: 10.1176/appi.ps.201400317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Because of pervasive poor general medical and mental health status among patients receiving Medicaid, there has been substantial debate about whether Medicaid, as currently financed and delivered, is better than no insurance. The study aimed to address whether insurance status is associated with the subsequent incidence and persistence of common mental disorders. METHODS Data came from a nationally representative U.S. population-based longitudinal survey that assessed mental disorders at two time points three years apart. Propensity score methods were used to adjust for potential confounding and to assess the association between three mutually exclusive insurance status groups (no insurance, private insurance only, and Medicaid only) and the subsequent incidence and persistence of mood, anxiety, and substance use disorders for persons ages 18-65 (N=26,410). RESULTS Compared with private insurance, lack of insurance was associated with higher odds of both the incidence and persistence of substance use disorders and with higher odds of persistence of any mood or anxiety disorder. Compared with having private insurance, having Medicaid insurance was associated with increased odds of persistent mood and anxiety disorders during follow-up. Overall, findings did not significantly differ between the uninsured and Medicaid groups. CONCLUSIONS The findings do not support prior reports that U.S. adults with Medicaid have worse mental health outcomes than uninsured adults. Lacking insurance may put individuals at higher risk of developing substance use disorders, and uninsured individuals with preexisting mental conditions were more likely to have mood, anxiety, and substance use problems that persist over time.
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Affiliation(s)
- Jitender Sareen
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Yunqiao Wang
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Natalie Mota
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Christine A Henriksen
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - James Bolton
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Lisa M Lix
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Ramin Mojtabai
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - O Joseph Bienvenu
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Rosa M Crum
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
| | - Tracie O Afifi
- Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: )
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Yehia F, Nahas Z, Saleh S. A roadmap to parity in mental health financing: the case of Lebanon. J Ment Health Policy Econ 2014; 17:131-141. [PMID: 25543116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Inadequate access to mental health (MH) services in Lebanon, where prevalence is noteworthy, is a concern. Although a multitude of factors affects access to services, lack of financial coverage of MH services is one that merits further investigation. AIM OF THE STUDY This study aims at providing a systematic description of MH financing systems with a special focus on Lebanon, presenting stakeholder viewpoints on best MH financing alternatives/strategies and recommending options for enhancing financial coverage. METHODS A comprehensive review of existing literature on MH financing systems was conducted, with a focus on the system in Lebanon. In addition, key stakeholders were interviewed to assess MH organizational and financing arrangements. Finally, a national round table was organized with the aim of discussing findings (from the review and interviews) and developing an action roadmap. RESULTS Taxation and out-of-pocket payments are the most common MH financing sources worldwide and in the Eastern Mediterranean Region. In Lebanon, all funding entities, except private insurance and mutual funds, cover inpatient and outpatient MH services, albeit with inconsistencies in levels of coverage. The national roundtable recommended two main MH financing enhancements: (i) creating a knowledge-sharing committee between insurers and MH specialists, and (ii) convincing labor unions/representatives to lobby for MH coverage as part of the negotiated benefit package. DISCUSSION There are concerns regarding the equity, effectiveness and efficiency of the MH financing system in Lebanon. The fragmented system in Lebanon leads to differences in MH coverage across different financing intermediaries, which is inequitable. The fact that one out of four Lebanese suffer a mental disorder throughout their lives and very low percentages of those obtain treatment signals a problem in effectiveness. As for efficiency, the inefficient fragmentation of MH financing among seven intermediaries is a problematic characteristic of the healthcare financing system as a whole. Moreover, the orientation of the general healthcare system towards curative rather than preventive care is reflected in MH financing as well. Limitations of the study include the lack of access to data about the MH expenditure of every financing intermediary in Lebanon; therefore it was not possible to calculate a total annual MH spending on a country level. Another limitation was the inability to map the sources of funding with the MH service provision sector, as more extensive data about the MH services provided by each of the public, private, voluntary and informal sectors is needed. IMPLICATIONS FOR HEALTH POLICIES Providing a clear description of the current MH financing system helps policymakers recognize the disparities present in the coverage of MH, guiding them into making informed decisions on allocation of funds. This study therefore constitutes the first step towards achieving more equitable and socially just coverage, advances knowledge and provides well-needed locally relevant research. Findings are expected to inform policymaking and have already contributed to influencing a change in the policy of the Internal Security Forces Health Fund. As a result of the roundtable discussion and follow up that ensued, the fund has removed the suicide attempt exclusion from its insurance policy.
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Affiliation(s)
| | | | - Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Vandyck Building Room 136A, Beirut, Lebanon,
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Zhou Y, Rosenheck RA, He H. Health insurance in China: variation in co-payments and psychiatric hospital utilization. J Ment Health Policy Econ 2014; 17:25-32. [PMID: 24864119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/01/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Economic reform in China 30 years ago virtually eliminated all public health insurance. In the last 10 years, diverse government insurance programs have been implemented, now covering 95% of the population, primarily for inpatient care. While the development of health care in China is an incomplete work in progress and highly variable, it is unclear whether the depth of insurance coverage affects the accessibility, length of stay (LOS) of inpatient mental health services or not. AIM OF THE STUDY This study aims to examine the relationship between variation in insurance coverage, accessibility to inpatient mental health care and intensity of care as measured by length of stay (LOS). METHODS Using administrative data from the Guangzhou Psychiatric Hospital (GPH), we used regression models to determine the relationship between the depth of insurance coverage and the likelihood of hospital utilization and LOS net of sociodemographic characteristics and diagnosis. RESULTS Between April 1, 2010 and March 31, 2013, 8,478 patients were discharged with ICD-10 psychiatric diagnoses with an average LOS of 75.1 (sd=244.3) days, among which 4,727 (55.8%) patients were first admissions. Logistic regression analysis showed that insurance plans with lower co-payments were significant predictors of multiple psychiatric admissions and longer LOS. IMPLICATIONS FOR HEALTH POLICY These data point to significant variability in the health insurance coverage in China and indicate a clear need for greater equalization in future years. Although the Chinese government has provided at least shallow coverage to virtually all of its citizens at this stage, further efforts are needed to expand and equalize coverage as economic development proceeds, especially in rural areas. IMPLICATIONS FOR FURTHER RESEARCH Although variation in health insurance plans in China are extensive and impact the accessibility and duration of psychiatric hospital care, their impact on outcomes and use of post-discharge outpatient care is unknown and requires further study.
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Affiliation(s)
| | | | - Hongbo He
- Neuropsychiatric research institute, Guangzhou Psychiatric Hospital, Guangzhou, China,
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Abstract
OBJECTIVE To evaluate the prevalence of atypical antipsychotic use in privately insured children and the diagnoses associated with treatment. STUDY DESIGN Claims were used to conduct a retrospective cohort study of children aged 2 through 18 years in the Midwest, covered by private insurance between 2002 and 2005 (n = 172,766). The 1-year prevalence of children receiving atypical antipsychotics was determined along with associated diagnoses. RESULTS The 1-year prevalence of atypical antipsychotics ranged from 7.9 per 1000 in 2002 to 9.0 in 2005. The leading diagnoses were disruptive behavior disorders (67%), mood disorders (65%), and anxiety disorders (43%).The authors found that 75% of children on atypical antipsychotics had more than one psychiatric diagnosis. CONCLUSIONS Atypical antipsychotic use is primarily seen in children who have multiple psychiatric diagnoses. Studies are needed to assess the long-term safety and effectiveness in such patients with multiple diagnoses.
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Affiliation(s)
- Donna R Halloran
- Department of Pediatrics, Saint Louis University, Saint Louis, MO 63104-1095, USA.
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Raghavan R, Lama G, Kohl P, Hamilton B. Interstate variations in psychotropic medication use among a national sample of children in the child welfare system. Child Maltreat 2010; 15:121-131. [PMID: 20410022 DOI: 10.1177/1077559509360916] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Geographic variations in service utilization have emerged as sentinels of quality of care. We used data from the National Survey of Child and Adolescent Well-Being (NSCAW), the Kaiser Family Foundation, and the Area Resource File to examine interstate variations in psychotropic medication use among children coming into contact with child welfare agencies. Mean probabilities of medication use differed by 13% between California (7.1%) and Texas (20.1%). On regression analyses, children in California had a fifth of the odds of medication use compared to children in Texas, principally, because child characteristics of age, gender, foster care placement, and mental health need seem to be evaluated differently in Texas compared to in other states. These findings suggest that interstate variations in psychotropic medication use are driven by child characteristics, rather than by mental health need. Understanding the clinical contexts of psychotropic medication use is necessary to assure high-quality care for these children.
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Affiliation(s)
- Ramesh Raghavan
- Brown School, Washington University, St. Louis, MO 63130, USA.
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Kawohl W, Nordt C, Warnke I, Kistler C, Ajdacic-Gross V, Rössler W. [Usage of inpatient treatments after reduction of inpatient capacities: Supply influences demand]. Neuropsychiatr 2010; 24:27-32. [PMID: 20146917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Next to socio-economic factors, subjective need, political and health economiaspects play an important role in the planning of psychiatric structures. The aim of this study was to assess the consequences of a reduction of inpatient capacities fort the usage of psychiatric inpatient care. METHODS The admissions of inpatients from a region in which the inpatient service has been replaced by the inpatient service from another region in the canton of Zurich, Switzerland, has been analysed. RESULTS Within the first two years after the omission of the service the admissions of patients with social health insurance policies from the relative sector decreased significantly as compared to the rest of the canton. In contrast to this, admissions of patients with private health insurances from the relative region and from the rest of the canton increased in a similar way. CONCLUSION It can be stated that in the first time after a reduction of inpatient capacities patients with social health insurance policies do not use inpatient alternatives even when these are easily accessible. This finding is meaningful for the arrangement of alternative offers for this very large group of patients in psychiatric health care planning.
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Affiliation(s)
- Wolfram Kawohl
- Forschungsgruppe Klinische und Experimentelle Psychopathologie.
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Abstract
OBJECTIVE Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. METHODS Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. RESULTS Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4-.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. CONCLUSIONS Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.
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Abstract
OBJECTIVE Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. METHODS Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. RESULTS Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4-.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. CONCLUSIONS Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.
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Fritze J. [Psychotherapy in private health insurance]. Versicherungsmedizin 2008; 60:35-36. [PMID: 18405235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Goldman HH. Considering health insurance parity for mental health and substance abuse treatment: the Federal Employees Health Benefits experience. Am J Psychiatry 2007; 164:1473-4. [PMID: 17898334 DOI: 10.1176/appi.ajp.2007.07071045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Howard H Goldman
- Psychiatric Services, American Psychiatric Association, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209, USA.
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Bramesfeld A, Grobe T, Schwartz FW. Who is treated, and how, for depression? An analysis of statutory health insurance data in Germany. Soc Psychiatry Psychiatr Epidemiol 2007; 42:740-6. [PMID: 17598055 DOI: 10.1007/s00127-007-0225-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies on the treatment of depression using epidemiological survey methods suggest a high level of under-treatment. Little is known about the characteristics of those people receiving treatment and indeed what kind of treatment they are likely to receive. METHOD Analysis of the data of a statutory health insurance company in Germany. RESULTS In middle-aged groups, about 50% of those diagnosed as being depressed in outpatient care are prescribed antidepressants and/or psychotherapy in the course of a year. There is more pharmacologic treatment provided in rural areas and more psychotherapy in cities, suggesting that treatment is dependent upon service availability rather than evidence-based treatment decisions. Treatment rates are considerably lower in the very young and the very old and show gender bias. Young females receive less pharmacologic treatment than young males, and elderly men are, in general, treated less than women, suggesting under-treatment at least for these groups. CONCLUSIONS The low treatment rates following the diagnosis of depression in the young and the old require attention, in particular with respect to gender aspect.
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Affiliation(s)
- Anke Bramesfeld
- Dept. for Epidemiology, Social Medicine, and Health System Research, Medical School Hannover, OE 5410, Carl Neunberg Strasse 1, 30625, Hannover, Germany.
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Lesser IM, Leuchter AF, Trivedi MH, Davis LL, Wisniewski SR, Balasubramani GK, Fava M, Rush AJ. Insured and non-insured depressed outpatients: how do they compare? Ann Clin Psychiatry 2007; 19:73-82. [PMID: 17612846 DOI: 10.1080/10401230701334671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to examine associations between clinical and demographic characteristics of depressed patients and source of payment for care. We attempted to confirm and extend findings from a previous study regarding the first 1500 participants enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with 2541 participants enrolled in later stages of the trial. METHODS Demographic, clinical, and presenting symptom features were compared among participants with public, private or no insurance. RESULTS Compared to those having private or no insurance, participants with public insurance were older; more likely to be women, Hispanic, widowed or divorced, unemployed, and less educated; were more frequently seen in primary care; had greater medical comorbidity and functional impairment, and a later age of depression onset. The publicly insured also had a longer current episode, but fewer episodes over their lifetime. Both the publicly insured and the uninsured had poorer life satisfaction compared to those with private insurance. Participants without insurance were intermediate between those with public and private insurance regarding several demographic characteristics and measures of severity. CONCLUSIONS Depressed outpatients with public insurance demonstrated greater functional impairment, though they did not have a more severe depression per se. Participants without insurance seemed to be a heterogeneous group with a presentation intermediate between those with public and private insurance. Those with public insurance were overrepresented in primary care clinics; therefore, clinicians in these settings need to be particularly vigilant in recognizing depression and offering appropriate treatments.
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Affiliation(s)
- Ira M Lesser
- Department of Psychiatry, Harbor-UCLA Medical Center, The Los Angeles Biomedical Research Institute, Los Angeles, CA, USA.
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Abstract
OBJECTIVE This study examined the rates and correlates of out-of-network outpatient mental health specialty care. RESEARCH DESIGN Using administrative data from a large insurer, we examine the frequency of out-of-network utilization, analyze demographic and clinical characteristics of individuals receiving out-of-network care, and examine the types of service provided out-of-network. RESULTS Out-of-network outpatient mental health care was received by 15.4% of adults who used outpatient mental health services, with 11.8% of adult outpatient mental health users receiving only out-of-network care and 3.6% receiving both in-network and out-of-network care. Out-of-network users received significantly more outpatient mental health care than individuals receiving only in-network mental health care. Rates of out-of-network psychotherapy services were substantially greater than for other commonly provided mental health services. CONCLUSION A significant number of patients covered under this insurer received their outpatient mental health care out-of-network. This is most pronounced for individuals receiving psychotherapy. Further information is needed to improve our understanding of who seeks care from out-of-network providers and why as well as the effect of such care on clinical outcomes.
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Kaplan DL. Can legislation alone solve America's mental health dilemma? Current state legislative schemes cannot achieve mental health parity. Quinnipiac Health Law J 2007; 8:325-61. [PMID: 17066557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Kapphahn C, Morreale M, Rickert VI, Walker L. Financing mental health services for adolescents: a background paper. J Adolesc Health 2006; 39:318-27. [PMID: 16919792 DOI: 10.1016/j.jadohealth.2006.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 04/27/2006] [Accepted: 06/13/2006] [Indexed: 11/27/2022]
Abstract
Good mental health provides an essential foundation for normal growth and development through adolescence and into adulthood. Many adolescents, however, experience mental health problems that significantly impede the attainment of their full potential. The majority of these adolescents do not receive needed mental health services, in part because of financial obstacles to care. This article reviews the magnitude and impact of mental health problems during adolescence and highlights the importance of insurance coverage in assuring access to mental health services for adolescents. Significant limitations in private health insurance coverage of mental health services are outlined. Recent federal and state efforts to move toward parity in private insurance coverage between mental and physical health services are discussed, including an explanation of the role of Medicaid and the State Children's Health Insurance Program (SCHIP) in providing access to mental health services for adolescents. Finally, other elements that would facilitate financial access to essential mental health services for adolescents are presented.
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Affiliation(s)
- Cynthia Kapphahn
- Division of Adolescent Medicine, Stanford University School of Medicine, Mountain View, California 94040, USA.
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Equal treatment for mental health: costs and benefits. Harv Ment Health Lett 2006; 23:7. [PMID: 16862707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Abstract
This article presents estimates of the proportion of the U.S. population that had mental health benefits in 1999, of the extent of their coverage, and of the proportion that were enrolled in health plans subject to the Mental Health Parity Act of 1996 (MHPA). Findings indicate that over three-quarters (76%) of the U.S. population had mental health benefits as part of their health insurance. Approximately 18% of the population had no mental health benefits, and for the remaining 6%, mental health benefits could not be determined. Of the 18% with no mental health benefits, most (84%) had no health insurance whatsoever, while the remainder (16%) had health insurance that did not cover mental health benefits. Estimates of the generosity of coverage indicate that 44% of the population had benefits that included prescription drugs, and that provided at least 30 inpatient days and 20 outpatient visits for psychiatric care. For 12% of the population, benefit generosity could not be determined. Finally, study results suggest that the MHPA affected only 42% of the U.S. population.
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Affiliation(s)
- Myles Maxfield
- Mathematica Policy Research, Inc., Maryland Ave., SW, Washington, DC, USA.
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Cameron CM, Purdie DM, Kliewer EV, McClure RJ. Mental health: a cause or consequence of injury? A population-based matched cohort study. BMC Public Health 2006; 6:114. [PMID: 16650287 PMCID: PMC1525178 DOI: 10.1186/1471-2458-6-114] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 05/02/2006] [Indexed: 11/18/2022] Open
Abstract
Background While a number of studies report high prevalence of mental health problems among injured people, the temporal relationship between injury and mental health service use has not been established. This study aimed to quantify this relationship using 10 years of follow-up on a population-based cohort of hospitalised injured adults. Methods The Manitoba Injury Outcome Study is a retrospective population-based matched cohort study that utilised linked administrative data from Manitoba, Canada, to identify an inception cohort (1988–1991) of hospitalised injured cases (ICD-9-CM 800–995) aged 18–64 years (n = 21,032), which was matched to a non-injured population-based comparison group (n = 21,032). Pre-injury comorbidity and post-injury mental health data were obtained from hospital and physician claims records. Negative Binomial regression was used to estimate adjusted rate ratios (RRs) to measure associations between injury and mental health service use. Results Statistically significant differences in the rates of mental health service use were observed between the injured and non-injured, for the pre-injury year and every year of the follow-up period. The injured cohort had 6.56 times the rate of post-injury mental health hospitalisations (95% CI 5.87, 7.34) and 2.65 times the rate of post-injury mental health physician claims (95% CI 2.53, 2.77). Adjusting for comorbidities and pre-existing mental health service use reduced the hospitalisations RR to 3.24 (95% CI 2.92, 3.60) and the physician claims RR to 1.53 (95% CI 1.47, 1.59). Conclusion These findings indicate the presence of pre-existing mental health conditions is a potential confounder when investigating injury as a risk factor for subsequent mental health problems. Collaboration with mental health professionals is important for injury prevention and care, with ongoing mental health support being a clearly indicated service need by injured people and their families. Public health policy relating to injury prevention and control needs to consider mental health strategies at the primary, secondary and tertiary level.
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Affiliation(s)
- Cate M Cameron
- School of Medicine, Griffith University, Meadowbrook, Australia
| | - David M Purdie
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Erich V Kliewer
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rod J McClure
- School of Medicine, Griffith University, Meadowbrook, Australia
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Abstract
This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Abstract
OBJECTIVE To examine the relationship between Hispanic ethnicity and language spoken with physician communication about depression and patient use of alternative treatments for depression. METHOD This is a secondary data analysis from a trial of depression screening conducted in four primary care clinics. Patients with Hispanic or non-Hispanic White ethnic backgrounds and those meeting DSM-III-R criteria for current major depression, minor depression, dysthymia as well as those that screened positive on a depression screening instrument (n = 141) are included in this analysis. We labeled those who screened positive for depression but did not meet DSM-IIIR criteria for a current depressive disorder as "distressed." Clinicians' use of counseling and patient use of alternative treatments were based on patient self-report. RESULTS Forty-two percent (n = 59) of the sample stated that their physician had either told them that they had depression, treated them for depression, or recommended that they seek help for depression. Over 40% of patients spent time talking with their physicians at their current visit about what was making them depressed and 34% received counseling about depression. Hispanic ethnicity and language were not significantly related to physician communication with patients about how to overcome depression. Thirty-six percent of patients reported talking with a minister or other religious person about feelings of depression or sadness. Seventeen percent of patients had used herbal remedies or non-prescription medications and 5% had seen a curandero for feelings of depression or sadness. Hispanic ethnicity and language were not significantly related to patient use of alternative treatments for depression. CONCLUSIONS Hispanic ethnicity and language were not significantly related to physician-patient communication about depression or patient use of alternative treatments for depression. Physicians should make sure to ask patients about all of the types of things they are doing to help overcome their depression.
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Affiliation(s)
- Betsy L Sleath
- University of North Carolina at Chapel Hill, Center for Health Services Research, NC 27599-3386, USA.
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Abstract
OBJECTIVE This study compared use of medical and behavioral health care by adolescents with bipolar disorder and other adolescents and identified areas in need of more clinical attention. METHODS Medical and behavioral health insurance claims from 1996 for 100,880 adolescents were examined and categorized. Differences between and among various categories of disease were explored by using multivariate analyses. RESULTS Among the 10,970 adolescents who used at least one behavioral health service, adolescents with bipolar disorder (N=326) had significantly higher behavioral health costs than those with mood or non-mood disorders, a result driven by these adolescents' significantly higher hospital admission rates for behavioral health care. Adolescents with bipolar disorder also had significantly higher medical admission rates compared with adolescents who had other behavioral health diagnoses. More than half of the 14 medical admissions for adolescents with bipolar disorder were due to drug overdose. CONCLUSIONS Reallocation of medical and behavioral health resources to improve ambulatory treatment of bipolar disorder among adolescents has the potential to decrease the use and costs of health care while improving the welfare of these adolescents and their families.
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Affiliation(s)
- Pamela B Peele
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
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Abstract
OBJECTIVE The objective of this research is to determine whether people with mental disorders are at increased risk for the subsequent development of malignancies compared with people without mental disorders. METHODS This is a retrospective cohort study of administrative claims data. The study population included 722,139 adults who filed at least one medical claim from 1989 to 1993. The mental disorder cohort included people with a) one psychiatric hospitalization, b) one outpatient psychiatrist visit, or c) two outpatient mental health claims occurring at least 6 months before a cancer claim. The controls were subjects filing claims for medical services who had no mental health visits. We calculated age-stratified odds ratios (ORs) for development of malignancy. RESULTS People with mental disorders were no more or less likely to develop a malignancy than those without after adjusting for age (women: OR, 1.03; 95% confidence interval [CI], 0.95-1.12; men: OR, 1.10; 95% CI, 0.97-1.24). People with mental disorders, however, developed cancer at younger ages and had increased odds of primary central nervous system tumors (women: OR, 2.12; 95% CI, 1.40-3.21; men: OR, 2.09; 95% CI, 1.22-3.59) and respiratory system cancers (women: OR, 1.57; 95% CI, 1.13-2.19; men: OR, 1.52; 95% CI, 1.09-2.12). CONCLUSIONS Insured people with mental disorder claims had an increased risk of certain malignancies and developed malignancies at younger ages. The increased odds of respiratory tumors are likely secondary to increased rates of smoking among people with mental disorders and support use of smoking cessation interventions in this population. The increased odds for brain tumors may reflect only the early presence of mental symptoms, or a true association between the two conditions. Further study of these findings is mandated.
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Affiliation(s)
- Caroline P Carney
- Department of Psychiatry, Regenstrief Institute, Indiana University School of Medicine, 1050 Wishard Blvd., RG6, Indianapolis, IN 46202-2872, USA.
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Koppelman J. Children with mental disorders: making sense of their needs and the systems that help them. NHPF Issue Brief 2004:1-24. [PMID: 15198110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This paper examines the nature, severity, and prevalence of mental, behavioral, and emotional disorders among children, as well as the types of services that could help them. It looks at how they are served by the education, health care, and child welfare systems, and it identifies the gaps in these systems of care. It also examines the extent to which Medicaid, SCHIP, and private health insurance finance mental health care services for children.
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Abstract
This article reviews recent evidence on changes over time in the direct medical costs of treating three of the more common mental health disorders in the US: the acute (16-week) phase of major depressive disorder, the ongoing treatment of schizophrenia, and the ongoing treatment of bipolar I disorders. The three studies discussed in this article cover various time intervals over the decade from 1991 through 2000, and encompass both private sector and governmental funding sources. Although there has been a shift over time away from intensive psychosocial/psychotherapy and towards increasingly expensive psychopharmacotherapy for all three disorders, total direct medical costs of treatment for each of these three mental health disorders have been declining over time. However, a substantial portion of treatment is not supported by clinical evidence.
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Affiliation(s)
- Ernst R Berndt
- Alfred P. Sloan School of Management, Massachusetts Institute of Technology, and the National Bureau of Economic Research, Cambridge, MA 02142, USA.
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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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Affiliation(s)
- Colleen L Barry
- Department of Health Policy, Harvard Medical School, Boston, USA
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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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Affiliation(s)
- Pamela B Peele
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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29
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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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Affiliation(s)
- Eric P Slade
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Baltimore, Maryland 21205-1901, USA.
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31
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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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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520-7900, USA.
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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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Affiliation(s)
- Tami L Mark
- Research and Pharmaceutical Division, Medstat, Washington, DC, USA
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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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Affiliation(s)
- John C Fortney
- Department of Veterans Affairs Health Services Research and Development Center for Healthcare and Outcomes Research, Little Rock, Arkansas, USA.
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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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Affiliation(s)
- Lynda Bryant-Comstock
- GlaxoSmithKline Research and Development, Global Health Outcomes, Research Triangle Park, NC 27709, USA.
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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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Affiliation(s)
- Yuhua Bao
- RAND Graduate School, Santa Monica, CA 90407, USA
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36
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Mark J Edlund
- UCLA Neuropsychiatric Institute, Los Angeles, CA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- L A Dimberg
- Health Services Department, The World Bank, Washington, DC 20433, USA
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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. Am J 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] [What about the content of this article? (0)] [Affiliation(s)] [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. Med Health R I 2001; 84:365-8. [PMID: 12355664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- D A Rochefort
- Dept. of Political Science, 303 Meserve Hall, Northeastern University, Boston, MA 02115-5000, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- S V Eisen
- Department of Mental Health Services Research, McLean Hospital, Belmont, MA 02478, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- S Geyer
- Medical Sociology, Medical University of Hannover, Germany.
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Hannon MJ, Roth D. Past and present insurance coverage in a public sector community mental health population. Adm Policy Ment Health 2001; 28:499-506. [PMID: 11804015 DOI: 10.1023/a:1012274726589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M J Hannon
- Office of Program Evaluation and Research at the Ohio Department of Mental Health in Columbus, USA.
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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. Adm Policy Ment Health 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- C Blodgett
- Washington State University at Spokane, Washington Institute for Mental Illness Research and Training, WA, USA
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Sharfstein SS, Dunn L, Kent JJ. The clinical consequences of payment limitations: the experience of a private psychiatric hospital. Psychiatr Hosp 2001; 19:63-6. [PMID: 10290271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [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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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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Affiliation(s)
- S F Greenfield
- Consolidated Department of Psychiatry, Harvard Medical School, Boston, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- D D McAlpine
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901-1293, USA
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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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Affiliation(s)
- D L Leslie
- Connecticut-Massachusetts VA Mental Illness Research, Education and Clinical Center, Department of Psychiatry, Yale School of Medicine, West Haven, CT 06516, USA.
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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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Affiliation(s)
- A Chabra
- California Department of Health Services, Maternal and Child Health Branch, Sacramento 94704, USA
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