Institute for Healthcare Policy and Innovation (Tipirneni, Patel, Goold, Kieffer, Ayanian, Clark, Lee, Bryant, Kirch, Solway), School of Public Health (Patel), School of Social Work (Kieffer), Child Health Evaluation and Research Center (Clark), and Institute for Social Research (Lee), all at the University of Michigan, Ann Arbor; Department of Internal Medicine (Tipirneni, Goold, Ayanian, Bryant, Luster), Center for Bioethics and Social Sciences in Medicine (Lewallen), and Department of Psychiatry (Zivin), all at the University of Michigan Medical School, Ann Arbor; Center for Clinical Management Research, U.S. Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Zivin).
Psychiatr Serv. 2020 Jan 1;71(1):4-11. doi: 10.1176/appi.ps.201900179. Epub 2019 Sep 25.
The study objective was to assess the impact of Medicaid expansion on health and employment outcomes among enrollees with and without a behavioral health disorder (either a mental or substance use disorder).
Between January and October 2016, the authors conducted a telephone survey of 4,090 enrollees in the Michigan Medicaid expansion program and identified 2,040 respondents (48.3%) with potential behavioral health diagnoses using claims-based diagnoses.
Enrollees with behavioral health diagnoses were less likely than enrollees without behavioral health diagnoses to be employed but significantly more likely to report improvements in health and ability to do a better job at work. In adjusted analyses, both enrollees with behavioral health diagnoses and those without behavioral health diagnoses who reported improved health were more likely than enrollees without improved health to report that Medicaid expansion coverage helped them do a better job at work and made them better able to look for a job. Among enrollees with improved health, those with a behavioral health diagnosis were as likely as those without a behavioral health diagnosis to report improved ability to work and improved job seeking after Medicaid expansion.
Coverage interruptions for enrollees with behavioral health diagnoses should be minimized to maintain favorable health and employment outcomes.
本研究旨在评估医疗补助扩大覆盖范围对有和无行为健康障碍（精神或物质使用障碍）参保者的健康和就业结果的影响。
在 2016 年 1 月至 10 月期间，作者对密歇根州医疗补助扩大计划的 4090 名参保者进行了电话调查，并使用基于索赔的诊断方法确定了 2040 名（48.3%）可能患有行为健康疾病的受访者。
有行为健康诊断的参保者比没有行为健康诊断的参保者更不可能就业，但他们更有可能报告健康状况改善和工作表现提高。在调整后的分析中，有行为健康诊断的参保者和报告健康状况改善但没有行为健康诊断的参保者，比健康状况没有改善的参保者更有可能报告说，医疗补助扩大覆盖范围帮助他们更好地完成工作，并使他们更有可能寻找工作。在健康状况改善的参保者中，有行为健康诊断的参保者和没有行为健康诊断的参保者在报告工作能力提高和在医疗补助扩大覆盖后寻找工作方面的可能性相同。
应尽量减少有行为健康诊断的参保者的覆盖中断，以维持有利的健康和就业结果。
