Journal of Mental Health Policy and Economics最新文献

Background: The COVID-19 pandemic has been widely reported to have increased symptoms of anxiety, depression, and other mental health issues. It may also have significantly disrupted continuity of treatment for existing patients and made access for those newly seeking care more difficult at a time when treatment needs are higher.

Aims of the study: This study seeks to examine the impact of the COVID-19 pandemic on mental health status and mental health treatment among adults residing in the U.S. civilian, non-institutionalized population.

Methods: The data are drawn from the 2019-2020 Medical Expenditure Panel Survey (MEPS), a nationally representative household survey of the U.S. civilian non-institutionalized population conducted annually since 1996 and used extensively to study mental health treatment in the U.S. I examine unadjusted and regression-adjusted differences between 2019 and 2020 in perceived mental health status (excellent, very good, good, fair, poor) and in the K6 general psychological distress, the PHQ-2 depression screener, and the VR-12 mental component summary score. Similarly, using the detailed MEPS data on health care encounters and prescription drug fills, I examine differences in mental health use treatment between 2019 and 2020. I focus specifically on changes in continuity of treatment among those already in treatment in January and February, before the pandemic fully struck, as well differences in the initiation of new episodes of treatment after the pandemic began.

Results: All four mental health scales included in the MEPS show statistically significant declines in mental health between 2019 and 2020, particularly among younger adults. On balance, the percentage of US adults receiving mental health treatment did not change significantly. Continuity of treatment increased slightly in 2020, with 87.1% of adults in treatment January or February still receiving care in the second quarter, an increase of 2.5 percentage points (p=.025). However, there were significant declines in the initiation of new episodes of treatment, especially in the second quarter of 2020.

Discussion: While the continuity of treatment among adults already in care when the COVID pandemic first led to nationwide disruptions is welcome news, the decline in new episodes of mental health treatment among those not previously treated is of great concern. In a time of heightened need, the gap between need and treatment likely grew larger. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE, AND IMPLICATIONS FOR HEALTH POLICIES: Continued long-term monitoring of the mental health needs and treatment gaps will be important, especially as many emergency measures designed to mitigate the effects of the pandemic on access to mental health treatment expire.

Background: While consumer cost-sharing is a widely used strategy to mitigate health care spending, numerous studies have demonstrated that even modest levels of out-of-pocket cost are associated with lower use of medical care, including clinically necessary, high-value services. Within mental health care, increases in cost-sharing are associated with reductions in use of mental health care and psychotropic medication use. Further, these reductions in mental health services and treatments can lead to downstream consequences including worsening of psychiatric illness and increased need for acute care and psychiatric hospitalization. Thus, there is a need for clinically informed solutions that explicitly balance the need for appropriate access to essential mental health services and treatments with growing fiscal pressures faced by public and private payers. Value-Based Insurance Design (VBID) describes a model where consumer cost-sharing is based on the potential clinical benefit rather than the price of a specific health care service or treatment.

Aims of the study: Describe value-based insurance design and applications in mental health care.

Results, discussion and implications for health policies: For over two decades, clinically nuanced VBID programs have been implemented in an effort to optimize the use of high-value health services and enhance equity through reduced consumer cost-sharing. Overall, the evidence suggests that VBID has demonstrated success in reducing consumer out-of-pocket costs associated with specific, high value services. By reducing financial barriers to essential clinical services and medications, VBID has potential to enhance equity. However, the impact of VBID on overall mental health care spending and clinical outcomes remains uncertain.

No abstract.