The Impact of National Health Care Reform on Adults With Severe Mental Disorders

• Published in: The American journal of psychiatry Vol. 168; no. 5; pp. 486 - 494
• Main Authors: Garfield, Rachel L., Zuvekas, Samuel H., Lave, Judith R., Donohue, Julie M.
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Publishing 01.05.2011; American Psychiatric Association
• Subjects: Adolescent; Adult; Biological and medical sciences; Confidence Intervals; Female; Health Care Reform - economics; Health Care Reform - legislation & jurisprudence; Health Expenditures; Health insurance; Health services; Humans; Income; Insurance Coverage - economics; Insurance Coverage - statistics & numerical data; Legislation; Male; Medicaid - statistics & numerical data; Medical sciences; Medically Uninsured - statistics & numerical data; Mental disorders; Mental Disorders - economics; Mental Disorders - therapy; Mental health; Mental health care; Mental Health Services - economics; Mental Health Services - legislation & jurisprudence; Mental Health Services - organization & administration; Mental Health Services - utilization; Middle Aged; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act; Propensity Score; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Social psychiatry. Ethnopsychiatry; United States; Young Adult; United States; North America; America; Human; Social environment; Health system; Health insurance; Help seeking; Legislation; Use; Mental health; Health service; Retrospective; Treatment; Young adult; Mental disorder; Adult; Reform; Predictive factor; Elderly; Public health
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2010.10060792

Objective:Little is known about the effect recent health care reform legislation will have on coverage of individuals with severe mental disorders. The authors examined current and predicted sources of insurance coverage and use of mental health services among adults with and without severe mental disorders and modeled postreform changes. Method:The authors obtained sociodemographic, health status, mental health care use, and insurance coverage data from the 2004–2006 Medical Expenditure Panel Surveys to estimate changes that will occur after reform is fully implemented in 2019. Results:Adults with severe mental disorders, identified as self-reported severe depression or other psychological distress, were more likely than those without such disorders to be uninsured (21.0% compared with 16.5%). Only one-fifth of individuals with severe mental disorders who lacked full-year insurance coverage had any mental health service use in the 2004–2006 period, compared with approximately half of those who had coverage. The authors estimate that the expansion of insurance coverage under reform will lead to 1.15 million new users of mental health services, which represents a 4.5% increase. The authors estimate an increase of 2.3 million users of mental health services in Medicaid and nearly 2 million in private insurance. Conclusions:Public insurance programs that currently play a major role in financing mental health services will play an even greater role after reform is implemented. Significant increases can be expected both in the overall number of users of mental health services and in their resources to pay for care.