Harju Amelia, Neufeld Jonathan
Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.
Telemed J E Health. 2021 Nov;27(11):1260-1267. doi: 10.1089/tmj.2020.0476. Epub 2021 Jan 11.
Low-income populations experience many barriers to accessing affordable, high-quality mental health services. One promising approach to improving access to care may be utilizing telemedicine in combination with expanding state Medicaid programs to cover low-income childless adults. This combination has the potential to reduce the prevalence of untreated mental illness; improve low-income populations' health and well-being; and save individuals', health care centers', and federal and state governments' money. A secondary data analysis on state Medicaid claims data was performed to calculate the percent difference in telemental health claims from 2014 through 2017 between two Medicaid expansion and two nonexpansion states in the Midwest. The percent change in claims during this time period within each of the four states was also calculated. Lastly, the difference between Medicaid telemental health utilization and other types of Medicaid telemedicine utilization was examined. The Medicaid expansion states (Iowa and Minnesota) had 54% more telemental health claims per 10,000 state population than nonexpansion states (Nebraska and Wisconsin) from 2014 through 2017. During this time period, Iowa, Minnesota, and Nebraska experienced 481%, 329%, and 12% increases in Medicaid telemental health claims, respectively, and Wisconsin experienced a 10% decrease. Medicaid telemental health utilization has been increasing since 2014 in the two Medicaid expansion states, especially in Iowa, while utilization has remained relatively constant in the two Medicaid nonexpansion states. This has implications for informing Medicaid policies, particularly with regard to Medicaid expansion and telemedicine reimbursement.
低收入人群在获得负担得起的高质量心理健康服务方面面临诸多障碍。一种有望改善就医机会的方法可能是将远程医疗与扩大州医疗补助计划相结合，以覆盖低收入的无子女成年人。这种结合有可能降低未治疗精神疾病的患病率；改善低收入人群的健康和福祉；并节省个人、医疗保健中心以及联邦和州政府的资金。对州医疗补助索赔数据进行了二次数据分析，以计算2014年至2017年期间中西部两个医疗补助扩大州和两个非扩大州之间远程心理健康索赔的百分比差异。还计算了这四个州中每个州在此期间索赔的百分比变化。最后，研究了医疗补助远程心理健康利用率与其他类型的医疗补助远程医疗利用率之间的差异。从2014年到2017年，医疗补助扩大州（爱荷华州和明尼苏达州）每10000名州人口的远程心理健康索赔比非扩大州（内布拉斯加州和威斯康星州）多54%。在此期间，爱荷华州、明尼苏达州和内布拉斯加州的医疗补助远程心理健康索赔分别增长了481%、329%和12%，而威斯康星州则下降了10%。自2014年以来，两个医疗补助扩大州的医疗补助远程心理健康利用率一直在上升，尤其是在爱荷华州，而在两个医疗补助非扩大州，利用率一直相对稳定。这对制定医疗补助政策具有启示意义，特别是在医疗补助扩大和远程医疗报销方面。
