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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
  • 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
  • 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
  • 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
  • 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)
  • 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: 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
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
summary
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
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
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