RÉSUMÉ
State policymakers have long sought to improve access to mental health and substance use disorder (MH/SUD) treatment through insurance market reforms. Examining decisions made by innovative policymakers ("policy entrepreneurs") can inform the potential scope and limits of legislative reform. Beginning in 2022, New Mexico became the first state to eliminate cost-sharing for MH/SUD treatment in private insurance plans subject to state regulation. Based on key informant interviews (n = 30), this study recounts the law's passage and intended impact. Key facilitators to the law's passage included receptive leadership, legislative champions with medical and insurance backgrounds, the use of local research evidence, advocate testimony, support from health industry figures, the severity of MH/SUD, and increased attention to MH/SUD during the COVID-19 pandemic. Findings have important implications for states considering similar laws to improve access to MH/SUD treatment.
RÉSUMÉ
OBJECTIVE: To provide new evidence on the effects of large-scale public health insurance expansions, associated with the Affordable Care Act (ACA), on the availability of specialty mental health care treatment in the United States. We measure availability with the probability that a provider accepts Medicaid. DATA SOURCE/STUDY SETTING: The National Mental Health Services Survey (N-MHSS) 2010-2018. STUDY DESIGN: A quasi-experimental differences-in-differences design using observational data. DATA COLLECTION: The N-MHSS provides administrative data on the universe of specialty mental health care providers in the United States. Response rates are above 90 percent in all years. Data cover 85 019 provider/year observations. PRINCIPAL FINDINGS: ACA-Medicaid expansion increases the probability that a provider accepts Medicaid by 1.69 percentage points, 95 percent confidence interval: [0.0017,0.0321], which corresponds to an increase from 87.27 percent pre-expansion to 90.27 percent postexpansion in expansion states or a 1.94 percent increase. We observe spillovers to Medicare, although this finding is sensitive to specification. CONCLUSIONS: This study provides evidence on the impact of ACA-Medicaid expansion on accepted forms of payment for specialty mental health care treatment. Findings suggest that expansion increases availability of providers who deliver valuable care for enrollees with severe mental illness. These findings may help policy makers reflecting on the future directions of the US health care delivery system.
Sujet(s)
Accessibilité des services de santé/organisation et administration , Couverture d'assurance/organisation et administration , Medicaid (USA)/organisation et administration , Medicare (USA)/organisation et administration , Troubles mentaux/thérapie , Services de santé mentale/organisation et administration , Patient Protection and Affordable Care Act (USA)/statistiques et données numériques , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Enfant d'âge préscolaire , Femelle , Politique de santé , Accessibilité des services de santé/statistiques et données numériques , Humains , Nourrisson , Nouveau-né , Couverture d'assurance/statistiques et données numériques , Mâle , Medicaid (USA)/statistiques et données numériques , Medicare (USA)/statistiques et données numériques , Services de santé mentale/statistiques et données numériques , Adulte d'âge moyen , États-Unis , Jeune adulteRÉSUMÉ
OBJECTIVE: To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions. DATA SOURCE/STUDY SETTING: Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC). STUDY DESIGN: A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization. DATA COLLECTION: The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N=43,093) in Wave I and 86.7 percent (N=34,653) in Wave II. PRINCIPAL FINDINGS: Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose-response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization. CONCLUSIONS: This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures.