Department of Public Policy, UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Box 951656, Los Angeles, CA, 90095-1656, USA.
AIDS Behav. 2020 Jun;24(6):1621-1631. doi: 10.1007/s10461-019-02663-w.
Medicare and Medicaid insurance claims data for Californians living with HIV are analyzed in order to determine: (1)The prevalence of treatment for particular mental health diagnoses among people living with HIV (PLWH) with Medicare or Medicaid insurance in 2010; (2)The relationship between individual mental health conditions and total medical care expenditures; (3)The impact of individual mental health diagnoses on the cost of treating non-mental health conditions; and (4)The implications of the cost of mental health diagnoses for setting managed care capitation payments. We find that the prevalence of mental health conditions among PLWH is high (23% among Medicare and 28% among Medicaid enrollees). PLWH with mental health conditions have significantly higher treatment costs for both mental health and non-mental health conditions. Setting managed care capitations that account for these greater expenditures is necessary to preserve access to both mental health and physical health services for PLWH and mental health conditions.
分析加利福尼亚州艾滋病毒感染者的医疗保险和医疗补助保险索赔数据，以确定：(1)2010 年，医疗保险或医疗补助保险覆盖的艾滋病毒感染者（PLWH）接受特定心理健康诊断治疗的流行率；(2)个体心理健康状况与总医疗支出之间的关系；(3)个体心理健康诊断对治疗非心理健康状况成本的影响；以及 (4)心理健康诊断成本对制定管理式医疗定额支付的影响。我们发现，PLWH 中心理健康状况的流行率很高（医疗保险中为 23%，医疗补助计划中为 28%）。患有心理健康状况的 PLWH 在心理健康和非心理健康状况方面的治疗费用明显更高。为了维护 PLWH 和心理健康状况的心理健康和身体健康服务的可及性，制定考虑到这些更高支出的管理式医疗定额支付是必要的。
