The Relationship between Insurance Coverage and Psychiatric Disorder in Predicting Use of Mental Health Services
ABSTRACT This study investigated how insurance coverage for mental health services affects outpatient mental health service utilization among those with and among those without a DSM-III psychiatric diagnosis. The authors used a representative community sample to compare the regression effects of insurance coverage on utilization of mental health services among these subjects.
Data are from the second wave of the Piedmont, North Carolina, site of the Epidemiologic Catchment Area project. These data contain DSM-III diagnostic measures derived from the National Institute of Mental Health Diagnostic Interview Schedule as well as measures of insurance coverage and utilization. Responses from 2,889 community residents were analyzed using both ordinary least squares and logistic regression.
In both models, insurance coverage was strongly associated with care among those with as well as among those without a psychiatric disorder. The association between coverage and the probability of care was strongest among those with a disorder.
The findings are not consistent with the claim that failing to provide insurance coverage will reduce discretionary but not necessary mental health care utilization. They provide evidence that failing to provide insurance coverage will reduce utilization as much or more among those with a psychiatric disorder as among those without. This result has important implications for health care reform.
- SourceAvailable from: Isok Kim
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- "Secondly, enabling factors either facilitate or impede access to MHS (Andersen 1995), which includes both resources available to the individual and its sociocultural characteristics. Health insurance and financial status are good examples of the resources influencing financial decision to access the MHS (Alegria et al. 2012; Landerman et al. 1994) and have been examined by a few studies (Jang et al. 2009; Kim et al. 2010). Sociocultural characteristics can be particularly relevant for immigrant populations. "
ABSTRACT: Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians.Community Mental Health Journal 03/2014; 50(8). DOI:10.1007/s10597-014-9719-6 · 1.03 Impact Factor
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- "The term " discretionary " implies that treatment is optional, not medically necessary, and thus, by definition, excessive. However, as Landerman et al. (1994) point out, this definition incorporates an economic concept of need that differs from a medical or public health perspective. Israeli data clearly challenge the notion of discretionary or excessive treatment. "
ABSTRACT: Untested assumptions concerning ambulatory treatment have shaped mental health policies for decades. Three opinions prevail: (1) all use is alike; (2) any use leads to high use; and (3) all high use is discretionary and therefore excessive. These assumptions were tested, using data from a nationwide survey of ambulatory utilizers in Israel, a country that has universal coverage. The findings, based on detailed clinical and treatment records, challenge all three assumptions. Moreover, they document a diversity of clinical needs while also verifying substantial variations in the type, frequency, and duration of treatment provided to meet those needs. In brief, Israeli data do not confirm continuing concerns by policy makers about uncontrollable use of services with expanded mental health coverage. Special policy limitations on mental health treatment should be reconsidered in light of empirical evidence from a system without the restrictions that exist in the United States.Milbank Quarterly 02/1997; 75(2):235-60. DOI:10.1111/1468-0009.00053 · 3.38 Impact Factor
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ABSTRACT: The efficacy of depression-targeted, time-limited psychotherapies as acute phase treatments for mild-to-moderately depressed outpatients with MDD is clear. It is often equal to medication, and may be preferred in milder, uncomplicated, nonchronic cases. Problem-solving therapy (PST) or Bibliotherapy (BBT) also appear efficacious in this population. Maintenance treatments appear beneficial but are exceeded by medication. However, converting medication responders into remitters with psychotherapy seems an effective approach.