Depressive symptoms and access to mental health care in women screened for postpartum depression who lose health insurance coverage after delivery: findings from the Translating Research into Practice for Postpartum Depression (TRIPPD) effectiveness study.

OBJECTIVE: To determine the impact of losing health insurance coverage on perceived need for and access to mental health care in women screened for postpartum depression (PPD) in primary care settings. PATIENTS AND METHODS: The study sample included 2343 women enrolled in a 12-month, multisite, randomized trial that compared clinical outcomes of a comprehensive PPD screening and management program with usual care (March 1, 2006, through August 31, 2010). Screening for PPD occurred at the first postpartum visit (5-12 weeks) using the Edinburgh Postnatal Depression Scale followed by the 9-item Patient Health Questionnaire. Insurance status during the prenatal period, at delivery, and during the first postpartum year and perceived need for and access to mental health care during the first postpartum year were assessed via questionnaires completed by individual patients and participating practices. RESULTS: Rates of uninsured increased from 3.8% during pregnancy and delivery (n=87 of 2317) to 10.8% at the first postpartum visit (n=253 of 2343) and 13.7% at any subsequent visit to the practice after 2 months post partum (n=226 of 1646) (P<.001, both comparisons vs baseline). For patients with data on insurance type during follow-up, insurance loss occurred primarily in Medicaid beneficiaries. Nine-item Patient Health Questionnaire scores and self-reported need for mental health care did not differ significantly between patients who remained insured and those who lost insurance during the first postpartum year. However, of patients who reported the need for mental health care, 61.1% of the uninsured (n=66 of 108) vs 27.1% of the insured (n=49 of 181) reported an inability to obtain mental health care (P<.001). CONCLUSION: Loss of insurance during the first postpartum year did not significantly affect depressive symptoms or perceived need for mental health care but did adversely affect self-reported ability to obtain mental health care.

Reaching out to retirees.

The numbers pertaining to the approaching demographic boom in health-care-related expenditures are eye-popping: Health-related financial products to help retiring baby boomers deal with out-of-pocket costs alone will generate up to 80 billion dollars in revenues and 8-12 billion dollars in pre-tax profits by 2014. But health insurers will have to refocus their efforts if they want to take full advantage of this opportunity. (For more, see "Turning Subscribers Into Customers: The Future Is Now" in the July/August issue, the first in this two-part series.) Two areas are critical: product innovation to provide comprehensive solutions that meet seniors' needs more effectively, and advice-based distribution that creates privileged customer relationships.

Turning subscribers into customers: the future is now.

The launch of Medicare's prescription drug plan marks a major milestone in federal health policy. Nearly 90 percent of Medicare's 43 million beneficiaries now have some form of prescription drug coverage, approximately 6 million of whom had no coverage prior to the introduction of Part D. The enrollment boom presents a tremendous opportunity for health insurers. But the new enrollments also present a challenge, as insurers' ability to build customer loyalty will depend on their success in reorienting themselves to the consumer market where tastes can be even more fickle than in the group business. The good news is that as insurers focus on serving senior customers, there is an even more promising opportunity on the horizon than Medicare Part D: providing products that help consumers-particularly retirees and those nearing retirement-to plan for and manage their out-of-pocket health care spending. The retirement health market beyond Medicare Advantage and Part D could significantly impact many health insurers' bottom line; it's expected to generate $80 billion in revenues and $8-$12 billion in pre-tax profits by 2014.

Maori spiritual beliefs and attitudes towards organ donation.

Organ transplantation is widely agreed to be beneficial to health. Many transplantations involve donation from the deceased. In Aotearoa/New Zealand, Maori both donate and receive proportionally fewer organs than non-Maori. This paper seeks illumination of this fact in unique Maori spiritual beliefs. These spiritual beliefs are not held by all Maori, and their role in an individual's life may vary, nonetheless they constitute a living tradition. Because cadaveric donation involves removal of organs from the dead person as soon after death as possible, considerations arise about customary rules and observances and the movement between the realm of the living and the dead. This may raise concerns for donors, recipients, and their respective whanau (extended family). In some cases, these concerns may form a consideration against donating posthumously.