Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, USA.
Am J Psychiatry. 2011 May;168(5):486-94. doi: 10.1176/appi.ajp.2010.10060792. Epub 2011 Feb 1.
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.
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.
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.
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.
关于最近的医疗改革立法将如何影响严重精神障碍患者的保险覆盖范围知之甚少。作者研究了当前和预测的保险来源以及有和没有严重精神障碍的成年人对精神卫生服务的使用情况，并对改革后的变化进行了建模。
作者从 2004-2006 年的医疗支出面板调查中获取了社会人口统计学、健康状况、精神卫生保健使用和保险覆盖数据，以估计在 2019 年改革全面实施后将发生的变化。
被认定为自我报告的严重抑郁症或其他心理困扰的严重精神障碍患者，比没有此类疾病的患者更有可能没有保险（21.0%比 16.5%）。在 2004-2006 年期间，没有全年保险覆盖的严重精神障碍患者中，只有五分之一的人使用了精神卫生服务，而有保险的患者中约有一半人使用了精神卫生服务。作者估计，改革中保险范围的扩大将导致新增 115 万精神卫生服务使用者，这代表增长了 4.5%。作者估计，医疗补助计划中的精神卫生服务使用者将增加 230 万，私人保险中增加近 200 万。
目前在为精神卫生服务提供资金方面发挥主要作用的公共保险计划在实施改革后将发挥更大的作用。预计精神卫生服务的总使用者数量及其支付护理费用的资源都将大幅增加。
