Slade Eric P, Salkever David S, Rosenheck Robert, Swanson Jeffrey, Swartz Marvin, Shern David, Gallucci Gerard, Harding Courtenay, Palmer Liisa, Russo Patricia, Hough Richard L, Barrio Concepcion, Garcia Piedad
Department of Psychiatry of the School of Medicine, University of Maryland, 737 West Lombard Street, Room 526, Baltimore, Maryland 21201, USA.
Psychiatr Serv. 2005 Aug;56(8):960-6. doi: 10.1176/appi.ps.56.8.960.
This study explored the association between Medicare cost-sharing requirements and the probability of use of various mental health outpatient services among Medicare enrollees with schizophrenia.
Multivariate logistic regression was used to estimate the probability of use of each of seven types of services over six months. Patients were recruited from public and private mental health treatment provider organizations in six states. The analyses included 1,088 Medicare enrollees, of whom approximately 55 percent were also enrolled in Medicaid.
Medicare-only patients (with greater cost-sharing) were 25 to 45 percent less likely to have used rehabilitation services, individual therapy with nonpsychiatrist mental health providers, and case management. No association was found between Medicaid enrollment and probability of service use for medical clinic visits, group therapy, individual contact with a psychiatrist, or receipt of second-generation antipsychotics.
Among Medicare enrollees with schizophrenia, gaps in Medicare coverage may be more problematic for rehabilitation, case management, and contact with nonpsychiatrist providers. Local public and private subsidies for mental health treatment may compensate for some of the gaps in coverage. However, such subsidies are not universally or uniformly provided.
本研究探讨了医疗保险费用分担要求与患有精神分裂症的医疗保险参保者使用各种心理健康门诊服务的可能性之间的关联。
采用多变量逻辑回归来估计六个月内使用七种服务类型中每种服务的可能性。患者从六个州的公立和私立心理健康治疗服务提供机构招募。分析纳入了1088名医疗保险参保者，其中约55%也参加了医疗补助计划。
仅参加医疗保险的患者（费用分担更高）使用康复服务、接受非精神科心理健康服务提供者的个体治疗以及接受病例管理的可能性要低25%至45%。在医疗补助计划参保情况与门诊就诊、团体治疗、与精神科医生的个体接触或接受第二代抗精神病药物治疗的服务使用可能性之间未发现关联。
在患有精神分裂症的医疗保险参保者中，医疗保险覆盖范围的缺口对于康复、病例管理以及与非精神科服务提供者的接触可能更成问题。地方对心理健康治疗的公共和私人补贴可能弥补部分覆盖缺口。然而，此类补贴并非普遍或统一提供。
