Mark Tami L, Hodgkin Dominic, Levit Katharine R, Thomas Cindy Parks
Dr. Mark and Ms. Levit are with the Center for Behavioral Health Services Research, Truven Health Analytics, Washington, D.C. (e-mail:
Psychiatr Serv. 2016 May 1;67(5):504-9. doi: 10.1176/appi.ps.201500034. Epub 2016 Jan 4.
Recessions are associated with increased prevalence of mental and substance use disorders, but their effect on use of behavioral health services is less clear. This study examined changes in spending per enrollee for behavioral health services compared with general medical services among individuals with private insurance following the Great Recession that began in 2007.
The National Survey on Drug Use and Health was used to examine the prevalence of behavioral health conditions among persons with private insurance from 2004 to 2013. Truven Health MarketScan Commercial Claims and Encounters data (2004-2012) were used to calculate use of and spending on treatment of behavioral and general medical conditions before and after the recession among individuals with employer-sponsored private health insurance.
There was a statistically significant increase in serious psychological distress and episodes of major depression between 2007 and 2010. Between 2004-2009 and 2009-2012, the growth in average annual spending per individual slowed for general medical care (from 6.6% to 3.7%) but accelerated for behavioral health care (from 4.8% to 6.6%). From 2009 to 2012, the percentage of individuals receiving inpatient treatment, outpatient treatment, and prescription drugs for behavioral conditions increased, whereas use of these services for general medical care decreased or remained flat. Out-of-pocket costs increased more slowly for behavioral conditions than for other medical conditions.
The recession was associated with increased need for and use of behavioral health services among individuals with private insurance. The Mental Health Parity and Addiction Equity Act may have also played a role in facilitating increasing use of behavioral health services after 2008.
经济衰退与精神和物质使用障碍患病率的增加有关，但其对行为健康服务使用的影响尚不清楚。本研究调查了2007年开始的大衰退后，拥有私人保险的个人在行为健康服务方面的人均支出与一般医疗服务相比的变化。
利用全国药物使用和健康调查来研究2004年至2013年期间拥有私人保险者的行为健康状况患病率。使用Truven Health MarketScan商业理赔和就诊数据（2004 - 2012年）来计算在经济衰退前后，拥有雇主赞助的私人健康保险的个人在行为和一般医疗状况治疗方面的使用情况和支出。
2007年至2010年期间，严重心理困扰和重度抑郁发作在统计学上有显著增加。在2004 - 2009年和2009 - 2012年期间，一般医疗护理的人均年支出增长放缓（从6.6%降至3.7%），但行为健康护理的人均年支出增长加速（从4.8%升至6.6%）。从2009年到2012年，接受行为疾病住院治疗、门诊治疗和处方药治疗的个人比例增加，而这些服务在一般医疗护理中的使用减少或保持平稳。行为疾病的自付费用增长比其他医疗状况更慢。
经济衰退与拥有私人保险的个人对行为健康服务的需求和使用增加有关。《精神健康平等和成瘾公平法案》可能也在2008年后促进行为健康服务使用增加方面发挥了作用。
