Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA.
Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.
J Rural Health. 2024 Jan;40(1):16-25. doi: 10.1111/jrh.12761. Epub 2023 Apr 23.
Medicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid-participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population.
Using 2018 Medicaid claims data, we identified enrollees aged 18-64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30- and 60-minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2-step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas.
Overall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30-minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access).
Some frontier areas with relatively poor access to Medicaid-participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.
农村和边境地区的医疗补助参保者获得心理健康服务的机会不足，但不同类型的提供者之间的机会差异程度尚不清楚。我们评估了获得参与医疗补助的处方和非处方心理健康临床医生的机会，重点是俄勒冈州，该州有大量的农村人口。
我们使用 2018 年医疗补助索赔数据，确定了在研究期间至少有一次向医疗补助报销的 18-64 岁有精神科诊断和专科精神卫生提供者的参保者。我们测量了到心理健康提供者的 30 分钟和 60 分钟车程，以及从增强型两步浮动捕获区（E2SFCA）方法在邮政编码分区（ZCTA）层面上获得的空间可达性评分。结果按开处方者和非开处方者、城市、农村和边境地区进行分层。
总体而言，大多数 ZCTA（68.6%）在 30 分钟车程内至少有 1 名心理健康处方者和非处方者。E2SFCA 测量结果表明，尽管边境 ZCTA 与其他地区相比，获得处方者的机会最低（最低五分位的 84.3%），但一些边境 ZCTA 获得非处方者的机会相对较高（第三和第四四分位的 34.3%）。
一些获得医疗补助参与的心理健康处方者机会较差的边境地区，获得非处方者的机会相对较高，这表明在农村劳动力资源有限的情况下，依赖非处方临床医生提供精神卫生保健。监测网络充足性的努力应考虑到不同提供者类型的不同机会，并采用 E2SFCA 等方法，更好地考虑服务需求和供应。
