The impact of national health reform on adults with mental disorders
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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.

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The impact of national health reform on adults with mental disorders

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
Background Disorders

  • 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
Objectives Disorders

  • 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
Data Source: MEPS Disorders

  • 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
Data: Key Variables Disorders

  • 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
Data: Key Variables (cont) Disorders

  • 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
Post-Reform Simulation: DisordersInsurance 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
Post-Reform Simulation: DisordersMental 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







Figure 2
Figure 2 Disorders


Figure 3
Figure 3 Disorders




Summary
Summary 133-400% FPL

  • 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
Implications 133-400% FPL

  • 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


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