Medicare and Disparities in Mental Health Treatment and Outcomes
- Presenter:
Chair: Sherry Glied; Discussant: Carole Gresenz Mon June 5, 2006 17:15-18:45 Room 332
Mental health disorders may affect up to half of all Americans, and can result in substantial lost productivity and premature death. Although most mental disorders are treatable using medication and other therapies, most sufferers do not get help. One reason may be due to incomplete health insurance coverage. In particular, approximately 13 percent of Americans lack any kind of health insurance coverage before the age of 65, a fraction that is even higher for minorities and individuals living in areas with low socioeconomic status. Turning age 65 and becoming Medicare eligible results in a significant improvement in mental health insurance coverage for Americans who are uninsured before the age of 65. (For most individuals age 65 and over, Medicare Part A covers psychiatric hospitalizations, while Medicare Part B covers 80% of outpatient visits for psychiatric medication management and 50% of approved charges for psychotherapy.) The effect of this improvement on the use of mental health services and on mental health will be tested using data from the National Ambulatory Medicare Care Survey (NAMCS), 1989, 1990, 1995-1996, and 1999-2003. The analysis estimates differences in mental health treatment by race and socioeconomic status of resident zip code both before and after age 65. Dependent variables will include the probability of a mental health visit among psychiatrists and primary care practitioners, as well as differences in the prescribing of psychotropic drugs including antidepressants, antipsychotics, and central nervous system (CNS) stimulants. Disparities in mental health treatment before and after age 65 also are examined using data on emergency room visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), psychiatric hospitalizations from the National Hospital Discharge survey, and suicide rates from vital statistics.
