Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance.
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ABSTRACT:
SUBMITTER: Kalmin MM
PROVIDER: S-EPMC10548294 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
Publications
Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance.
Kalmin Mariah M MM Cantor Jonathan H JH Bravata Dena M DM Ho Pen-Che PC Whaley Christopher C McBain Ryan K RK
JAMA network open 20231002 10
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Project description:ObjectiveTo examine how characteristics vary between children with any mental health (MH) diagnosis who have typical spending and the highest spending; to identify independent predictors of highest spending; and to examine drivers of spending groups.MethodsThis retrospective analysis utilized 2016 Medicaid claims from 11 states and included 775,945 children ages 3 to 17 years with any MH diagnosis and at least 11 months of continuous coverage. We compared demographic characteristics and Medicaid expenditures based on total health care spending: the top 1% (highest-spending) and remaining 99% (typical-spending). We used chi-squared tests to compare the 2 groups and adjusted logistic regression to identify independent predictors of being in the top 1% highest-spending group.ResultsChildren with MH conditions accounted for 55% of Medicaid spending among 3- to 17-year olds. Patients in the highest-spending group were more likely to be older, have multiple MH conditions, and have complex chronic physical health conditions (P <.001). The highest-spending group had $164,003 per-member-per-year (PMPY) in total health care spending, compared to $6097 PMPY in the typical-spending group. Ambulatory MH services contributed the largest proportion (40%) of expenditures ($2455 PMPY) in the typical-spending group; general health hospitalizations contributed the largest proportion (36%) of expenditures ($58,363 PMPY) in the highest-spending group.ConclusionsAmong children with MH conditions, mental and physical health comorbidities were common and spending for general health care outpaced spending for MH care. Future research and quality initiatives should focus on integrating MH and physical health care services and investigate whether current spending on MH services supports high-quality MH care.
| S-EPMC7340572 | biostudies-literature
Project description:ObjectivesThis study examines the impact of extreme temperatures on hospital utilization and public health insurance program spending in a country with no universal health coverage.MethodsUsing nationwide U.S. county-level panel data and a fixed effects model, we estimate the impact of annual variations in the number of hot and cold days on hospital utilization and medical reimbursements for low-income and elderly beneficiaries of public health insurance.ResultsOur results show that extreme heat and mild cold increase medical reimbursements to low-income beneficiaries, while extreme cold increases benefit transfer to the elderly. We find that extreme temperatures have particularly stronger positive effect on hospital admission and inpatient care utilization among old and poor patients. The fiscal impact of extreme temperatures is greater in areas with more generous income eligibility criteria for public health insurance.ConclusionThe study advances our understanding of how extreme temperatures affect healthcare utilization of low-income and elderly populations and the roles public health insurance plays in supporting them from increasing weather risks. Our findings suggest that climate change can augment the financial burden on governments.
| S-EPMC11859587 | biostudies-literature
Project description:ObjectiveThis study examined changes in utilization of mental health services after Hurricane Katrina among children with preexisting conditions who were displaced from their homes in Louisiana disaster counties and resettled in Texas.MethodsA retrospective analysis was performed on Medicaid claims data for 101,950 children from 2004 to 2006. Pre-post changes in utilization of mental health services by the displaced children and three control groups were compared. The control groups were children from Louisiana disaster counties who were not displaced, Louisiana children from nondisaster counties, and Texas children enrolled in Medicaid.ResultsThe proportion of children who had a prescription fill for psychotropic medication and the average days' supply per child decreased in each group, but the decreases were significantly larger for the displaced group than for the control groups. The decreases in both measures were largest for stimulants and antidepressants, the two most common medication classes. By contrast, changes in the proportion of children with an encounter involving psychiatric services and the average number of psychiatric services encounters per child did not vary systematically across the displaced and control groups.ConclusionsThe contrast between the results for medication utilization and encounters reveals a potential gap in post-Katrina provision of care. Although the findings for encounters indicate that, on average, displaced children did not experience a disruption in provider visits, the medication estimates suggest that they often did not obtain pharmaceutical treatment. Future disaster responses may be improved by addressing logistical impediments faced by disaster victims in filling their prescriptions for psychiatric medications.
| S-EPMC11227124 | biostudies-literature
Project description:ObjectiveTo explore the relationship between commercial health care prices and Medicare spending/utilization across U.S. regions.Data sourcesClaims from large employers and Medicare Parts A/B/D over 2007-2009.Study designWe compared prices paid by commercial health plans to Medicare spending and utilization, adjusted for beneficiary health and the cost of care, across 301 hospital referral regions.Principal findingsA 10 percent lower commercial price (around the average level) is associated with 3.0 percent higher Medicare spending per member per year, and 4.3 percent more specialist visits (p < .01).ConclusionsCommercial health care prices are negatively associated with Medicare spending across regions. Providers may respond to low commercial prices by shifting service volume into Medicare. Further investigation is needed to establish causality.
| S-EPMC4450935 | biostudies-literature
Project description:ObjectiveMillions of low-income Americans will gain health insurance through Medicaid under the Affordable Care Act. This study assesses the impact of previous Medicaid expansions on mental health services utilization and out-of-pocket spending.Data sourcesSecondary data from the 1998-2011 Medical Expenditure Panel Survey Household Component merged with National Health Interview Survey and state Medicaid eligibility rules data.Study designInstrumental variables regression models were used to estimate the impact of expanded Medicaid eligibility on health insurance coverage, mental health services utilization, and out-of-pocket spending for mental health services.Data extraction methodsPerson-year files were constructed including adults ages 21-64 under 300 percent of the Federal Poverty Level.Principal findingsMedicaid expansions significantly increased health insurance coverage and reduced out-of-pocket spending on mental health services for low-income adults. Effects of expanded Medicaid eligibility on out-of-pocket spending were strongest for adults with psychological distress. Expanding Medicaid eligibility did not significantly increase the use of mental health services.ConclusionsPrevious Medicaid eligibility expansions did not substantially increase mental health service utilization, but they did reduce out-of-pocket mental health care spending.
| S-EPMC4693850 | biostudies-literature
Project description:Using eight two-year panels from the Medical Expenditure Panel Survey data for the period 2004 to 2012, we examine the effect of economic shocks on mental health spending by families with children. Estimating two-part expenditure models within the correlated random effects framework, we find that employment shocks have a greater impact on mental health spending than do income or health insurance shocks. Our estimates reveal that employment gains are associated with a lower likelihood of family mental health services utilization. By contrast employment losses are positively related to an increase in total family mental health. We do not detect a link between economic shocks and mental health spending on behalf of fathers.
| S-EPMC7014816 | biostudies-literature
Project description:ImportanceDespite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services.ObjectiveTo determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care.Design, setting, and participantsThe COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021.InterventionsMI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments.Main outcomes and measuresThe primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up.ResultsAmong 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years. Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005).Conclusions and relevanceIn this study, use of MI in specialized pediatric consultations did not increase the use of mental health care services among youths with CMCs but did lead to longer patient-physician conversations and lower anxiety scores at 1 year. Additional research is required to determine whether varying scope and duration of MI training for physicians could encourage youths with CMCs to seek counseling and thus improve integrated care models.Trial registrationGerman Trials Registry: DRKS00014043.
| S-EPMC8486984 | biostudies-literature
Project description: Not available
| S-EPMC10457709 | biostudies-literature
Project description:ImportanceValue-based insurance design (VBID) has mostly been used in improving medication use and adherence for certain conditions or patients, but its outcomes remain uncertain when applied to other services and to all health plan enrollees.ObjectiveTo determine the association of participation in a California Public Employees' Retirement System (CalPERS) VBID program with its enrollees' health care spending and utilization.Design, setting, and participantsA retrospective cohort study with difference-in-differences propensity-weighted 2-part regression models was performed in 2021 to 2022. A VBID cohort was compared with a non-VBID cohort both before and after VBID implementation in California in 2019 with 2 years' follow-up. The study sample included CalPERS preferred provider organization continuous enrollees from 2017 through 2020. Data were analyzed from September 2021 to August 2022.ExposuresThe key VBID interventions include (1) if selecting and using a primary care physician (PCP) for routine care, PCP office visit copayment is $10 (otherwise, PCP office visit copayment is $35 as for specialist visit); and (2) annual deductibles reduced by a half through completion of the following 5 activities: annual biometric screening, influenza vaccine, nonsmoking certification, second opinion for elective surgical procedures, and disease management participation.Main outcomes and measuresThe primary outcome measures included annual per member total approved payments for multiple inpatient and outpatient services.ResultsThe 2 compared cohorts of 94 127 participants (48 770 were female [52%]; 47 390 were younger than 45 years old [50%]) had insignificant baseline differences after propensity-weighting adjustment. The VBID cohort had significantly lower probabilities of inpatient admissions (adjusted relative odds ratio [OR], 0.82; 95% CI, 0.71-0.95), and higher probabilities of receiving immunizations (adjusted relative OR, 1.07; 95% CI, 1.01-1.21) in 2019. Among those with positive payments, VBID was associated with higher mean total allowed amounts for PCP visits in 2019 and 2020 (adjusted relative payments ratio, 1.05; 95% CI, 1.02-1.08). There were no significant differences for inpatient and outpatient combined totals in 2019 and 2020.Conclusions and relevanceThe CalPERS VBID program achieved desired goals for some interventions with no added total costs in its first 2 years of operation. VBID may be used to promote valued services while containing costs for all enrollees.
| S-EPMC10011939 | biostudies-literature
Project description:ImportanceConcussion may exacerbate existing mental health issues. Little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems.ObjectiveTo investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm, or suicides.Design, setting, and participantsThis population-based retrospective cohort study including children and youths aged 5 to 18 years with a concussion or orthopedic injury incurred between April 1, 2010, and March 31, 2020, in Ontario, Canada. Participants had no previous mental health visit in the year before the index event for cohort entry and no prior concussion or traumatic brain injury 5 years before the index visit. Data were collected from provincewide health administrative databases. Participants with concussion were included in the exposed cohort, and those with an orthopedic injury were included in the comparison cohort; these groups were matched 1:2, respectively, on age and sex.ExposuresConcussion or orthopedic injury.Main outcomes and measuresThe primary outcome was mental health problems, such as psychopathologies and psychiatric disorders, identified from health care visits in emergency departments, hospitalizations, or primary care settings. Secondary outcomes were psychiatric hospitalizations, self-harm health care visits, and death by suicide (identified in health care or vital statistics databases).ResultsA total of 152 321 children and youths with concussion (median [IQR] age, 13 [10-16] years; 86 423 [56.7%] male) and 296 482 children and youths with orthopedic injury (median [IQR] age, 13 [10-16] years; 171 563 [57.9%] male) were matched by age and sex. The incidence rates of any mental health problem were 11 141 per 100 000 person-years (exposed group) and 7960 per 100 000 person-years (unexposed group); with a difference of 3181 (95% CI, 3073-3291) per 100 000 person-years. The exposed group had an increased risk of developing a mental health issue (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.37-1.40), self-harm (aHR, 1.49; 95% CI, 1.42-1.56), and psychiatric hospitalization (aHR, 1.47; 95% CI, 1.41-1.53) after a concussion. There was no statistically significant difference in death by suicide between exposed and unexposed groups (HR, 1.54; 95% CI, 0.90-2.61).Conclusions and relevanceAmong children and youths aged 5 to 18 years, concussion was associated with an increased risk of mental health issues, psychiatric hospitalization, and self-harm compared with children and youths with an orthopedic injury.
| S-EPMC8902648 | biostudies-literature