Alcohol, Drug Abuse, and Mental Health Care for Uninsured and Insured Adults

RAND, Santa Monica, CA 90407-2138, USA.
Health Services Research (Impact Factor: 2.78). 09/2002; 37(4):1055-66. DOI: 10.1034/j.1600-0560.2002.65.x
Source: PubMed


To compare adults with different insurance coverage in care for alcohol, drug abuse, and mental health (ADM) problems.
From a national telephone survey of 9,585 respondents.
Follow-up of adult participants in the Community Tracking Study.
Self-report survey of insurance plan (Medicare, Medicaid, unmanaged, fully, or partially managed private, or uninsured), ADM need, use of ADM services and treatments, and satisfaction with care in the last 12 months. PRINCIPAL METHODS: Logistic and linear regressions were used to compare persons by insurance type in ADM use.
The likelihood of ADM care was highest under Medicaid and lowest for the uninsured and those under Medicare. Perceived unmet need was highest for the uninsured and lowest under Medicare. Persons in fully rather than partially managed private plans tend to be more likely to have ADM care and ADM treatments given need. Satisfaction with care was high in public plans and low for the uninsured.
The uninsured have the most problems with access to and quality of ADM care, relative to the somewhat comparable Medicaid population. Persons in fully managed plans had better rather than worse access and quality compared to partially managed plans, but findings are exploratory. Despite low ADM use, those with Medicare tend to be satisfied. Across plans, unmet need for ADM care was high, suggesting changes are needed in policy and practice.

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    • "They are also highest in young males, with comorbid alcohol/drug disorder. Elevated rates of poverty, unemployment and lack of insurance (where applicable) are linked with excess mortality and these factors may also hinder these individuals' access to basic medical services (Saitz et al., 2004; Wells et al., 2002). In those with severe mental illness at risk of hepatitis C, one group found that ethnicity (being black), gender (male) or living in a community with high exposure to community violence lowered those odds of receiving appropriate care (Swartz et al., 2003). "
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    ABSTRACT: We have previously documented inequalities in the quality of medical care provided to those with mental ill health but the implications for mortality are unclear. We aimed to test whether disparities in medical treatment of cardiovascular conditions, specifically receipt of medical procedures and receipt of prescribed medication, are linked with elevated rates of mortality in people with schizophrenia and severe mental illness. We undertook a systematic review of studies that examined medical procedures and a pooled analysis of prescribed medication in those with and without comorbid mental illness, focusing on those which recruited individuals with schizophrenia and measured mortality as an outcome. From 17 studies of treatment adequacy in cardiovascular conditions, eight examined cardiac procedures and nine examined adequacy of prescribed cardiac medication. Six of eight studies examining the adequacy of cardiac procedures found lower than average provision of medical care and two studies found no difference. Meta-analytic pooling of nine medication studies showed lower than average rates of prescribing evident for the following individual classes of medication; angiotensin converting enzyme inhibitors (n = 6, aOR = 0.779, 95% CI = 0.638-0.950, p = 0.0137), beta-blockers (n = 9, aOR = 0.844, 95% CI = 0.690-1.03, p = 0.1036) and statins (n = 5, aOR = 0.604, 95% CI = 0.408-0.89, p = 0.0117). No inequality was evident for aspirin (n = 7, aOR = 0.986, 95% CI = 0.7955-1.02, p = 0.382). Interestingly higher than expected prescribing was found for older non-statin cholesterol-lowering agents (n = 4, aOR = 1.55, 95% CI = 1.04-2.32, p = 0.0312). A search for outcomes in this sample revealed ten studies linking poor quality of care and possible effects on mortality in specialist settings. In half of the studies there was significantly higher mortality in those with mental ill health compared with controls but there was inadequate data to confirm a causative link. Nevertheless, indirect evidence supports the observation that deficits in quality of care are contributing to higher than expected mortality in those with severe mental illness (SMI) and schizophrenia. The quality of medical treatment provided to those with cardiac conditions and comorbid schizophrenia is often suboptimal and may be linked with avoidable excess mortality. Every effort should be made to deliver high-quality medical care to people with severe mental illness.
    Journal of Psychopharmacology 11/2010; 24(4 Suppl):69-80. DOI:10.1177/1359786810382056 · 3.59 Impact Factor
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    • "In depressive and anxiety disorders, about two-thirds of people with a disorder receive no mental health treatment at all (Young et al., 2001). People are particular unlikely to access mental health care if they have no insurance or insurance that is not managed (Wells et al., 2002). Only one-fifth of people with a disorder see a mental health specialist. "
    2nd pages 177-208; Oxford University Press.
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