影响 Medicaid 乳腺癌受益人群获得心理健康服务的因素
Factors Influencing Receipt of Mental Health Services Among Medicaid Beneficiaries With Breast Cancer.
机构信息
Dr. Halpern is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia. Dr. Fiero is with the Office of Biostatistics, U.S. Food and Drug Administration, Silver Spring, Maryland.
出版信息
Psychiatr Serv. 2018 Mar 1;69(3):332-337. doi: 10.1176/appi.ps.201700024. Epub 2017 Nov 15.
OBJECTIVE
This study examined associations of state-level Medicaid reimbursement and other policies and patient characteristics with receipt of mental health diagnostic and treatment services for beneficiaries with cancer.
METHODS
Data (2006-2008) from Medicaid beneficiaries with breast cancer were analyzed to examine predictors of receiving mental health diagnostic services and mental health treatment services. Independent variables included state-level Medicaid policies for reimbursements for mental health services and consultations (requests from one health care provider to another for advice regarding evaluation or management of a specific problem), required patient copayments, and requirements governing the timing of Medicaid eligibility recertification (eligibility recertification period). Generalized estimating equations were used to assess factors influencing receipt of mental health services while controlling for clustering by state.
RESULTS
The analysis of diagnostic services included 7,441 Medicaid beneficiaries, and the analysis of treatment services included 7,511 beneficiaries. Medicaid reimbursements for mental health services were not associated with receiving these services. However, increased Medicaid reimbursement for consultations significantly increased the likelihood of receiving mental health diagnostic and treatment services. Increased comorbidities were also associated with increased likelihood of receiving mental health services.
CONCLUSIONS
The association of higher Medicaid reimbursements for consultations with receipt of mental health services suggests that consultation reimbursement has a "gatekeeper" effect-after a patient received an initial consultation, lower reimbursements for mental health services were not barriers to subsequent mental health care. Increased Medicaid reimbursement for consultations with a mental health professional may increase willingness of health care providers to provide mental health care services for Medicaid beneficiaries.
目的
本研究旨在调查州级医疗补助报销政策及其他政策和患者特征与癌症患者接受心理健康诊断和治疗服务之间的关联。
方法
分析了乳腺癌 Medicaid 受益人的数据（2006-2008 年），以检验接受心理健康诊断服务和心理健康治疗服务的预测因素。自变量包括州级医疗补助心理健康服务和咨询报销政策（一个医疗保健提供者向另一个医疗保健提供者请求有关特定问题评估或管理的建议）、要求患者共付额以及管理医疗补助资格重新认证时间的要求（资格重新认证期）。使用广义估计方程来评估在控制按州聚类的情况下影响心理健康服务接受情况的因素。
结果
诊断服务分析包括 7441 名 Medicaid 受益人和治疗服务分析包括 7511 名受益人。心理健康服务的医疗补助报销与接受这些服务无关。然而，增加医疗补助对咨询的报销显著增加了接受心理健康诊断和治疗服务的可能性。合并症的增加也与接受心理健康服务的可能性增加有关。
结论
较高的医疗补助对咨询报销与接受心理健康服务之间的关联表明，咨询报销具有“把关人”效应-在患者接受初始咨询后，心理健康服务的较低报销不是后续心理健康护理的障碍。增加与心理健康专业人员的医疗补助咨询报销可能会增加医疗保健提供者为 Medicaid 受益提供心理健康护理服务的意愿。
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