The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire2National Bureau of Economic Research, Cambridge, Massachusetts.
Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
JAMA Psychiatry. 2014 Apr;71(4):404-11. doi: 10.1001/jamapsychiatry.2013.3972.
Young adults have high levels of behavioral health needs but often lack health insurance. Recent health reforms have increased coverage, but it is unclear how use of hospital-based care changed after expanding insurance. OBJECTIVE To evaluate the association between health insurance coverage expansions and use of hospital-based care among young adults with behavioral health diagnoses.
DESIGN, SETTING, AND PARTICIPANTS: Quasi-experimental analyses of community hospital inpatient and emergency department use from 2003-2009 based on hospital discharge data, comparing differential changes in service use among young adults with behavioral health diagnoses in Massachusetts vs other states before and after Massachusetts' 2006 health reform. This population-based sample included inpatient admissions (n = 2,533,307, representing 12,821,746 weighted admissions across 7 years) nationwide and emergency department visits (n = 6,817,855 across 7 years) from Maryland and Massachusetts for 12- to 25-year-old patients.
Inpatient admission rates per 1000 population for primary diagnosis of any behavioral health disorder by diagnosis; emergency department visit rates per 1000 population by behavioral health diagnosis; and insurance coverage for hospital discharges.
After 2006, uninsurance among 19- to 25-year-old individuals in Massachusetts decreased from 26% to 10% (16 percentage points; 95% CI, 13-20). Young adults experienced relative declines in inpatient admission rates of 2.0 per 1000 for primary diagnoses of any behavioral health disorder (95% CI, 0.95-3.2), 0.38 for depression (95% CI, 0.18-0.58), and 1.3 for substance use disorder (95% CI, 0.68-1.8). The increase in emergency department visits with any behavioral health diagnosis after 2006 was lower among young adults in Massachusetts compared with Maryland (16.5 per 1000; 95% CI, 11.4-21.6). Among young adults in Massachusetts, the percentage of behavioral health discharges that were uninsured decreased by 5.0 (95% CI, 3.0-7.2) percentage points in inpatient settings and 5.0 (95% CI, 1.7-7.8) percentage points in emergency departments relative to other states.
Expanded health insurance coverage for young adults was not associated with large increases in hospital-based care for behavioral health, but it increased financial protection for young adults with behavioral health diagnoses and for the hospitals that care for them.
年轻人的行为健康需求水平较高，但往往缺乏医疗保险。最近的医疗改革增加了覆盖范围，但扩大保险后，医院为基础的护理使用情况如何变化尚不清楚。目的：评估在扩大医疗保险覆盖范围后，有行为健康诊断的年轻人使用医院为基础的护理的情况。
设计、地点和参与者：基于医院出院数据的 2003-2009 年社区医院住院和急诊部门使用情况的准实验分析，比较了马萨诸塞州和其他州的年轻人在行为健康诊断方面的服务使用差异变化，比较了马萨诸塞州 2006 年医疗改革前后的情况。该基于人群的样本包括全国范围内的住院入院（n=2533307，代表 7 年内 12821746 次加权入院）和马里兰州和马萨诸塞州的急诊就诊（n=6817855 次，7 年内），患者年龄为 12 至 25 岁。
按诊断原发性任何行为健康障碍的每 1000 人口的住院入院率；按行为健康诊断的每 1000 人口的急诊就诊率；以及出院时的医疗保险覆盖范围。
2006 年后，19-25 岁的年轻人在马萨诸塞州的无保险比例从 26%降至 10%（16 个百分点；95%置信区间，13-20）。年轻人的原发性任何行为健康障碍诊断的住院入院率相对下降了 2.0/1000（95%置信区间，0.95-3.2），抑郁的 0.38（95%置信区间，0.18-0.58），以及物质使用障碍的 1.3（95%置信区间，0.68-1.8）。与马里兰州相比，马萨诸塞州的年轻人在 2006 年后急诊就诊的任何行为健康诊断的增加幅度较低（每 1000 人增加 16.5 人；95%置信区间，11.4-21.6）。在马萨诸塞州，行为健康出院者中无保险的比例在住院环境中下降了 5.0（95%置信区间，3.0-7.2），在急诊部门下降了 5.0（95%置信区间，1.7-7.8），与其他州相比。
扩大年轻人的医疗保险范围并没有导致对行为健康的大量增加，但增加了对有行为健康诊断的年轻人和为他们提供护理的医院的经济保护。
