The Effect of Insurance Benefit Changes and Use of Child Adolescent Outpatient Mental Health Services

Duke University, Durham, North Carolina, United States
Medical Care (Impact Factor: 3.23). 03/1993; 31(2):96-110. DOI: 10.1097/00005650-199302000-00002
Source: PubMed


Use of outpatient mental health services by dependent children younger than 18 years of age enrolled in the Blue Cross and Blue Shield Federal Employees Plan (FEP) is examined in 1978 and 1983 focusing on a cut in benefits and a shift from high- to low-option plan enrollment between those years. While use rates increased from 2.13% to 2.76% by 1983, the average number of visits decreased from 18.9 to 12.8. High-option plan use exceeded low-option plan use in both years--2.26% versus 0.81% in 1978 and 3.58% versus 1.93% in 1983. In addition to benefit plan, ethnicity, parent's education, type of provider, and type of treatment setting also significantly predicted amount of use. Despite the strong evidence of the effects of benefit coverage, it is likely that need exceeded use even in this insured population of children and adolescents. Implications of the findings are discussed in the context of recent dramatic changes in mental service delivery including privatization, managed care initiatives to cut costs, and growing pressures for national health insurance.

8 Reads
  • Source
    • "It is known that economics drives a significant portion of variability in seeking and receiving treatment for both White and ethnic minority members of the population. Insurance coverage significantly influences utilization of mental health services for adults and children (Padgett et al. 1993; Wu et al. 2001). Socioeconomic variables and family structure have a strong influence on service use for ethnic groups (Pumariega et al. 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article is written for the practitioners treating depression in ethnic minority youth. It will review the context in which services are delivered to these youth: Researchers have recognized persistent ethnic differences in terms of utilization of services and unmet need. Furthermore, when ethnic minority youth do receive pediatric mental health care, the services that they receive may differ from those given to White patients. The reasons for these discrepancies have been examined in numerous studies, and have included contextual variables (economics, availability, and accessibility of services), patient variables (differences in prevalence or manifestation of the disorder, cultural beliefs and attitudes, preferential use of alternative or informal services, health literacy, and adherence), and provider variables (referral bias and patient-provider communication). Information about the differences between White and minority youth in the pharmacodynamics and pharmacokinetics of the antidepressant response is still limited. There are significant challenges for developing evidence-based guidelines that inform practice with these youth, hinging on both the underrepresentation of ethnic minority groups in clinical trials, and the great variability in biological and cultural characteristics of individuals in ethnic minority categories. Awareness on the part of the practitioner of the cultural variables that influence help-seeking and ongoing utilization of mental health services may aid in the engagement, effective treatment, and retention of ethnic minority children and adolescents with depression. However, given the great heterogeneity that exists within any cultural grouping, clinicians will need to integrate information about cultural patterns with that obtained from the individual patient and family to inform optimal practices for each patient. This article is written to enhance awareness on the part of the practitioner as to the variables that influence psychiatric care for depression in culturally diverse youth. The mental health needs of minority youth are not well served: They are treated less frequently, and when they are treated, the services they receive are less frequently adequate. The reasons that have been proposed for the disparities in their care, particularly with regard to diagnosis and treatment for depression, will be reviewed. They include contextual factors (such as economics, insurance, and other variables affecting the availability of services) patient and family factors (such as prevalence, symptom presentation, and values and beliefs that influence whether patients are referred to and avail themselves of services), and provider factors (such as referral bias and patient-provider communication, which affect whether patients engage and stay in treatment). The implications for the practitioner treating ethnic minority youth with depression will be discussed. Culture, as used in this article, refers to the common values, beliefs, and social behaviors of individuals with a shared heritage. Some aspects of culture that are likely to influence service utilization include health beliefs, particularly regarding models of mental illness, and level of stigma toward mental health treatment, which are frequently shared by individuals in a cultural group. However, some caveats for the explanatory potential of "culture" should be kept in mind. Conventions for naming groups vary between investigators and over time (e.g., the restriction of the category "White" into "White NonHispanic," is quite recent). Although heterogeneity is assumed within a named cultural or racial group, the terms Hispanic, Asian, and African-American incorporate subgroups can be very different in linguistic, historical, and geographical ancestry (e.g., Stewart 2008 ), and each group incorporates individuals who may not share any components of their historical heritage. Even among those with historical ties, values, beliefs, and social behaviors can vary according to the extent to which they identify with the mainstream culture. Social class frequently creates a "culture" of its own, with individuals in the same social class across traditional cultural groupings sharing disparities in care, and many beliefs and values. Individuals are likely to belong to numerous "cultures," and may not share specific typical behaviors or beliefs with any of them.
    Full-text · Article · Feb 2012 · Journal of child and adolescent psychopharmacology
  • Source
    • "Commonly examined child characteristics include demographic and clinical status variables. In terms of child characteristics, findings regularly reveal that male children are more likely to be referred and use mental health services in comparison to female children [31] [32], and they tend to use more services when involved in treatment [33] [34]. As children get older, the disparity between rates of service use by gender tends to decrease [31] [35]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To increase the involvement of urban youth and families who need mental health services, child mental health agencies and providers might consider the following: (1) examining intake procedures and developing interventions to target specific barriers to service use; (2) providing training and supervision to providers to increase a focus on engagement in the first face-to-face meetings with youth and families; (3) providing service delivery options with input from consumers regarding types of services offered. Involvement of youth and their families is a primary goal that must receive as much attention as any other part of the service delivery process. One might argue that without youth and family participation, effective services never will be provided to youth and families in need.
    Full-text · Article · Nov 2004 · Child and Adolescent Psychiatric Clinics of North America
  • Source
    • "service use and costs among children (Farmer, Stangl, Bums, et al. 1999; Gresenz, Liu, and Sturm 1998; Padgett, Patrick, Bums, et al. 1993). The goal of managed care is to reduce total health costs by substituting less costdy outpatient care for expensive inpatient services (Goldman, McCulloch, and Sturm 1998), using such mechanisms as utilization review, exclusive contracts with selected providers, and risk sharing. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine trends in mental health service use and cost among privately insured children. Inpatient and outpatient claims from the MarketScan database, a collection of health care claims for a national sample of over seven million privately insured individuals. Claims were analyzed for all users of mental health services 17 years of age and under from 1993 to 1996. The proportion of children receiving mental health services and annual costs and treatment days per treated child were compared across diagnostic groups over time. The proportion of covered children receiving any mental health services fell substantially (-30.0 percent). Inpatient mental health costs per treated child fell $4,587 (-46.9 percent) during the period, driven by decreases in the number of hospital days per treated child per year (-22.9 percent) and per diem costs (-14.5 percent). Outpatient mental health costs also fell during the period due to a 5.1 percent decline in the number of treatment days and a 25.9 percent fall in costs per day. Children whose primary diagnosis was hyperactivity experienced the largest decrease in inpatient costs per treated patient, those diagnosed with schizophrenia experienced the smallest decrease, and those diagnosed with substance abuse disorders experienced large increases. Changes in mental health service delivery have resulted in substantially reduced access to mental health care among children and significant declines in service use and costs among those who do receive services.
    Preview · Article · May 2001 · Health Services Research
Show more