Wilson Amy Blank, Phillips Jonathan, Parisi Anna, Ishler Karen J, Villodas Melissa, Francis Annie
School of Social Work, University of North Carolina At Chapel Hill, 325 Pittsboro St., Campus Box 3550, Chapel Hill, NC, 27599-3550, USA.
Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
Community Ment Health J. 2022 May;58(4):729-739. doi: 10.1007/s10597-021-00878-7. Epub 2021 Aug 27.
Disruptions in Medicaid adversely affect service use and outcomes among individuals with serious mental illnesses (SMI). A retrospective longitudinal study examined Medicaid coverage and service utilization patterns among individuals with SMI (N = 8358) from 2007 to 2010. Only 36% of participants were continuously enrolled in Medicaid and 20% experienced multiple enrollment disruptions. Mental health diagnosis did not predict continuous coverage; however, individuals with schizophrenia were 19% more likely to have multiple coverage disruptions than those with depression (b = - 0.21; p < 0.01). Single and multiple coverage disruptions were associated with decreased rates of outpatient service days utilized (IRR = 0.77 and 0.65, respectively, p < 0.001) and decreased odds of not using acute care services (OR 0.26 and 0.19, respectively, p < 0.001). Future research should explore mechanisms underlying Medicaid stability and develop interventions that facilitate insurance stability and service utilization.
医疗补助计划的中断对患有严重精神疾病（SMI）的个体的服务使用和治疗结果产生不利影响。一项回顾性纵向研究调查了2007年至2010年期间患有严重精神疾病（N = 8358）的个体的医疗补助覆盖情况和服务利用模式。只有36%的参与者持续参加医疗补助计划，20%的人经历了多次参保中断。心理健康诊断并不能预测持续参保情况；然而，与患有抑郁症的人相比，患有精神分裂症的人出现多次参保中断的可能性要高19%（b = -0.21；p < 0.01）。单次和多次参保中断与门诊服务天数使用率降低（风险比分别为0.77和0.65，p < 0.001）以及未使用急性护理服务的几率降低（优势比分别为0.26和0.19，p < 0.001）相关。未来的研究应探索医疗补助稳定性的潜在机制，并制定促进保险稳定性和服务利用的干预措施。
