Harvard University.
Columbia University.
Milbank Q. 2018 Mar;96(1):29-56. doi: 10.1111/1468-0009.12311.
Policy Points: We take advantage of Oregon's Medicaid lottery to gauge the causal effects of Medicaid coverage on mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression. Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50% and untreated depression by more than 60%. It increased use of medications and reduced the share of respondents reporting unmet mental health care needs by almost 40%. There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable populations.
Expanding Medicaid to previously uninsured adults has been shown to increase detection and reduce the prevalence of depression, but the ways that Medicaid affects mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression remain unclear.
We take advantage of Oregon's Medicaid lottery to gauge the causal effects of Medicaid coverage using a randomized-controlled design, drawing on both primary and administrative data sources.
Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50% and untreated depression by more than 60%. It increased use of medications frequently prescribed to treat depression and related mental health conditions and reduced the share of respondents reporting unmet mental health care needs by almost 40%. The share of respondents screening positive for depression dropped by 9.2 percentage points overall, and by 13.1 for those with preexisting depression diagnoses, with greatest relief in symptoms seen primarily in feeling down or hopeless, feeling tired, and trouble sleeping-consistent with the increase observed not just in medications targeting depression but also in those targeting sleep.
Medicaid coverage had significant effects on the diagnosis, treatment, and outcomes of a population with substantial unmet mental health needs. Coverage increased access to care, reduced the prevalence of untreated and undiagnosed depression, and substantially improved the symptoms of depression. There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable populations.
政策要点：我们利用俄勒冈州的医疗补助彩票来评估医疗补助覆盖对心理健康护理的因果影响，评估其满足未满足需求的效果，以及这些效果在有和没有抑郁病史的人群中的差异。医疗补助覆盖降低了未确诊的抑郁症患病率近 50%，未治疗的抑郁症患病率超过 60%。它增加了药物的使用，将报告未满足心理健康护理需求的受访者比例降低了近 40%。关于医疗补助覆盖对弱势群体的政策决策可能会对心理健康产生重大影响。
为以前没有保险的成年人扩大医疗补助范围已被证明可以提高发现率并降低抑郁症的患病率，但医疗补助对心理健康护理的影响方式、满足未满足需求的效果以及有和没有抑郁病史的人群中的差异仍不清楚。
我们利用俄勒冈州的医疗补助彩票来利用随机对照设计来衡量医疗补助覆盖的因果影响，利用主要和行政数据源。
医疗补助覆盖降低了未确诊的抑郁症患病率近 50%，未治疗的抑郁症患病率超过 60%。它增加了经常用于治疗抑郁症和相关心理健康状况的药物的使用，并将报告未满足心理健康护理需求的受访者比例降低了近 40%。整体而言，抑郁筛查呈阳性的受访者比例下降了 9.2 个百分点，对于已有抑郁诊断的受访者比例下降了 13.1%，症状缓解最大的是情绪低落或绝望、疲倦和睡眠困难——这与不仅针对抑郁症的药物而且针对睡眠的药物的增加相一致。
医疗补助覆盖对有大量未满足心理健康需求的人群的诊断、治疗和结果产生了重大影响。覆盖范围扩大了获得护理的机会，降低了未治疗和未确诊的抑郁症患病率，并大大改善了抑郁症的症状。关于医疗补助覆盖对弱势群体的政策决策可能会对心理健康产生重大影响。
