Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck).
Psychiatr Serv. 2021 Oct 1;72(10):1160-1167. doi: 10.1176/appi.ps.201900571. Epub 2021 May 11.
Insurance status and continuity may affect access to and quality of care. The authors characterized patterns of and changes in insurance status over 1 year among people with first-episode psychosis (FEP), comparing insurance patterns with adults of similar age in the general population.
Longitudinal data on insurance status and predictors of insurance status among adults with FEP were obtained from RAISE-ETP (Recovery After an Initial Schizophrenia Episode-Early Treatment Program) study participants with complete 1-year data (N=288). The frequencies of insurance status and transitions are presented. Bivariate comparisons were used to assess the impact of the comprehensive coordinated care intervention in RAISE-ETP on insurance changes. These data were compared with contemporaneous longitudinal data in the 2011 Medical Expenditures Panel Study.
The RAISE-ETP experimental intervention did not significantly change insurance status. At baseline, levels of uninsurance (47%) and public insurance (31%) were higher among RAISE-ETP participants than among a similar age group in the general public (29% and 13%, respectively). Insurance transitions were common among people with FEP, although 79% of those with public insurance at baseline also had public insurance at 1 year. Of studied RAISE-ETP participants, 60% had a period of uninsurance during the year studied.
Compared with a national sample, people with FEP were more likely to use public insurance but still had high persistence of 12-month uninsurance. That over half of the RAISE-ETP participants had a period of uninsurance suggests that more research is needed on whether these periods affect treatment continuity and medication adherence.
保险状况和连续性可能会影响获得医疗服务的机会和医疗服务质量。作者描述了首发精神病患者（FEP）在一年内保险状况的变化模式，并将其与一般人群中具有相似年龄的成年人的保险模式进行了比较。
从 RAISE-ETP（首次精神分裂症发作后的早期治疗计划）研究参与者中获得了有关 FEP 成年人保险状况及其预测因素的纵向数据，这些参与者具有完整的 1 年数据（N=288）。呈现了保险状况的频率和变化。使用二变量比较评估了 RAISE-ETP 中的综合协调护理干预对保险变化的影响。将这些数据与同期的 2011 年医疗支出面板研究的纵向数据进行了比较。
RAISE-ETP 实验性干预并未显著改变保险状况。在基线时，RAISE-ETP 参与者的未参保率（47%）和公共保险率（31%）高于一般人群中具有相似年龄组的参保率（29%和 13%）。FEP 患者的保险变化很常见，尽管有 79%的人在基线时有公共保险，但在 1 年内仍有公共保险。在研究的 RAISE-ETP 参与者中，有 60%在研究期间有一段时间没有保险。
与全国样本相比，首发精神病患者更有可能使用公共保险，但仍有 12 个月的未参保率较高。超过一半的 RAISE-ETP 参与者有一段时间没有保险，这表明需要更多的研究来确定这些时期是否会影响治疗的连续性和药物的依从性。
