190 likes | 354 Views
The Impact of National Health Reform on Adults with Mental Disorders. Rachel L. Garfield, Ph.D. Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health Samuel H. Zuvekas, Ph.D. Agency for Healthcare Research & Quality Judith R. Lave, Ph.D.
E N D
The Impact of National Health Reform on Adults with Mental Disorders Rachel L. Garfield, Ph.D. Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health Samuel H. Zuvekas, Ph.D. Agency for Healthcare Research & Quality Judith R. Lave, Ph.D. Julie Donohue, Ph.D. Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health
Background • Insurance coverage important determinant of access to mental health treatment (Landerman et al 1994, Zuvekas 1999, McAlpine and Mechanic 2000, Kessler et al. 2005, Roy-Byrne et al 2009) • Potential for significant impact of the Patient Protection and Affordable Care Act of 2010 on individuals with mental disorders: • <133 % of Federal Poverty Line (FPL) eligible for Medicaid • 133-400% of FPL eligible for exchange subsidies • Parity in Mental Health Coverage
Objectives • Examine current sources of insurance coverage and use of mental health services among adults with mental disorders • Simulate post-reform changes: • health insurance coverage • mental health treatment use
Data Source: MEPS • Medical Expenditure Panel Survey (2004-2006) • Large nationally, representative survey • Key variables: • Health insurance coverage • Family income and poverty status • Mental health treatment use • Mental health status • Pooled to increase precision • N=51,080 adults aged 18-64
Data: Key Variables • Mental Health Status (Adult SAQ) • PHQ-2 2-Item Depression Screener (PHQ-2>=3) • K6 General Psychological Distress (K6>=13) • Family Income • Based on Health Insurance Eligibility Units • <133%,133-400%, 400+ of poverty
Data: Key Variables (cont) • Health Insurance Coverage • Medicare (including duals) • full year private • full year Medicaid • uninsured part-year • uninsured full year • Mental Health Treatment Use • Any inpatient, hospital outpatient, ED, office or clinic visit, or prescription drug fill for mental health reason
Post-Reform Simulation: Insurance Coverage • Apply CBO assumptions on takeup rates: • 59% decrease overall in the uninsured • <133% of FPL uninsured switch to Medicaid • >133% of FPL uninsured switch into Private coverage. • Enrollment in Medicare stable
Post-Reform Simulation: Mental Health Treatment Use • Regression model of the impact of health insurance coverage on use of treatment: • Logistic regression • Controls for age, race/ethnicity, sex, education, region and MSA, family income, insurance status, mental health status, physical health status, attitudes and preferences towards insurance and health care • Will apply CBO assumptions on take-up rates
Simulated Impact of Reform on Mental Health Service Use: Uninsured <133% FPL
Simulated Impact of Reform on Mental Health Use: Uninsured 133-400% FPL
Summary • Adults with mental disorders have lower incomes and are more likely to be uninsured than their counterparts • Adults with mental disorders are significantly more likely to be enrolled in Medicare and/or Medicaid than those without • Only one-quarter of individuals with mental disorders who lack insurance coverage for the full year had any mental health service use in 2004-2006 compared to approximately half of those with coverage • After reform is fully implemented, we estimate 3.7 million currently uninsured individuals with mental disorders will gain coverage, with approximately one-third covered under Medicaid • We estimate that use of mental health treatment could double among those previously uninsured
Implications • Health reform is likely to have a significant impact on coverage and use of services among adults with mental disorders. • Will depend on implementation and capacity of mental health system to absorb increased demand • Public insurance programs that currently play a major role in financing mental health services will play an even greater role post-reform