Factors that Affect Choice of Mental Health Provider and Receipt of Outpatient Mental Health Treatment.

According to the US Department of Health and Human Services, 91 million adults live in mental health professional shortage areas and 10 million individuals have serious mental illness (SMI). This study examines how the supply of psychiatrists, severity of mental illness, out-of-pocket costs, and health insurance type influence patients' decisions to receive treatment and the type of provider chosen. Analyses using 2012-2013 MarketScan Commercial Claims data showed that patients residing in an area with few psychiatrists per capita had a higher predicted probability of not receiving follow-up care (46.4%) compared with patients residing in an area with more psychiatrists per capita (42.5%), and those in low-psychiatrist-supply areas had a higher predicted probability of receiving prescription medication only (10.2 vs 7.6%). Patients with SMI were more likely than those without SMI to obtain treatment. A $25 increase in out-of-pocket costs had marginal impact on patients' treatment choices.

Racial Disparities in Sepsis-Related In-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004-2013.

OBJECTIVES: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths. DESIGN: Retrospective, repeated cross-sectional study. SETTING: Acute care hospitals in the Healthcare Cost and Utilization Project State Inpatient Databases for 18 states with consistent race/ethnicity reporting. PATIENTS: Patients diagnosed with septicemia, sepsis, organ dysfunction plus infection, severe sepsis, or septic shock. MEASUREMENTS AND MAIN RESULTS: In-hospital sepsis mortality rates adjusted for patient and hospital factors by race/ethnicity were calculated. From 2004 to 2013, sepsis hospitalizations for all racial/ethnic groups increased, and mortality rates decreased by 5-7% annually. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white (92.0 per 1,000 sepsis hospitalizations), black (94.0), and Hispanic (93.5) patients but remained elevated for Asian/Pacific Islander (106.4) and "other" (104.7; p < 0.001) racial/ethnic patients. CONCLUSIONS: Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations.

Role of insurance, income, and affordability in human papillomavirus vaccination.

OBJECTIVES: To examine knowledge of and financial barriers to early adoption of human papillomavirus (HPV) vaccination, specifically the role played by insurance, income, and affordability (measured by forgoing or delaying needed medical care due to cost/no insurance). STUDY DESIGN: We used the 2007 California Health Interview Survey. Females aged 18 to 26 years (n = 1840) and parents with daughters aged 8 to 17 years (n = 5765) were analyzed separately. METHODS: Logistic regression models were used with the following dependent variables: (1) heard of the HPV vaccine, (2) received 1 dose only, (3) completed the series, (4) have not previously heard of HPV vaccine but interested in receiving it, and (5) interested and willing to pay $360 for it. RESULTS: Individuals enrolled in private health maintenance organizations (HMOs) were more likely to have heard of the vaccine compared with the uninsured and those enrolled in public HMOs. Young adults enrolled in private HMOs were also more likely to have initiated HPV vaccination or completed the series compared with uninsured young adults or those insured in non-HMO plans. Higher income parents were more willing to pay the cost of the vaccine. Forgoing needed care due to costs led to lower odds of initiating HPV vaccination among parents and completing the series among young adults. CONCLUSIONS: Strategies to increase HPV vaccination rates should consider insurance or cost barriers for adults and those with high medical care expenditures. Disparities in receipt of the HPV vaccine are likely to continue without targeted outreach to more vulnerable populations.