Xie Yujia, Harati Pravara, Rajbhandari-Thapa Janani, Serban Nicoleta
Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, 755 Ferst Dr NW, Atlanta, 30332, Georgia.
Georgia Department of Public Health, Atlanta, Georgia.
BMC Public Health. 2025 Jan 20;25(1):244. doi: 10.1186/s12889-025-21374-7.
Evaluating access to psychosocial services can inform policy decision-making on ways to address shortages in the availability of mental health (MH)-specialized providers. The objective of the study was to assess how the mental health (MH)-specialized workforce met the demand for psychosocial services of Medicaid-insured children in Georgia, with direct relevance in establishing quantitative network adequacy.
We used the 2018 Medicaid (TAF) claims data, the 2018 National Plan and Provider Enumeration System database, and the 2019 Georgia school-based program data to estimate community-level demand and practice-level supply of psychosocial services. We evaluated the availability of services using mathematical models. The outcome measures were met demand and travel distance. We explored the impact of increasing in-home care delivery, expanding Medicaid participation, or increasing caseload for the Medicaid-participating providers on improving met demand for psychosocial services.
Our findings showed that 34% of the demand from Medicaid-insured children in Georgia remained unmet, and 25% of the Georgia census tracts (rural 79%; urban 16%) had < 50% service coverage. The travel distance for in-clinic services was 3.84 miles on average. Increasing provider Medicaid caseload or expanding Medicaid participation, resulting in a 5-40% supply increase, would reduce unmet demand to 7% and decrease the number of unserved and underserved census tracts to 3% and 2% respectively. Meeting 75% of the demand required a 15% increase in the supply.
The main source of network inadequacy was the scarcity of MH providers available to Medicaid-insured children in Georgia, coming from both the limited caseload of existing MH providers and low Medicaid participation, rather than travel constraints. Increasing provider caseload and expanding Medicaid participation were found to reduce unmet demand. Interventions increasing caseloads were the most effective intervention since existing Medicaid-participating providers already had sufficient network coverage geographically.
评估心理社会服务的可及性可为解决心理健康专业服务提供者短缺问题的政策决策提供参考。本研究的目的是评估心理健康专业人员队伍如何满足佐治亚州医疗补助参保儿童的心理社会服务需求，这对于确定定量的网络充足性具有直接相关性。
我们使用了2018年医疗补助（TAF）索赔数据、2018年国家计划和提供者枚举系统数据库以及2019年佐治亚州基于学校的项目数据，以估计社区层面心理社会服务的需求和实践层面的供给。我们使用数学模型评估服务的可及性。结果指标为需求满足情况和出行距离。我们探讨了增加上门护理服务、扩大医疗补助参与度或增加参与医疗补助的提供者的工作量对提高心理社会服务需求满足率的影响。
我们的研究结果表明，佐治亚州医疗补助参保儿童34%的需求未得到满足，25%的佐治亚州人口普查区（农村地区为79%；城市地区为16%）服务覆盖率低于50%。门诊服务的平均出行距离为3.84英里。增加提供者的医疗补助工作量或扩大医疗补助参与度，使供给增加5%-40%，将使未满足的需求降至7%，并将无服务和服务不足的人口普查区数量分别降至3%和2%。满足75%的需求需要供给增加15%。
网络不足的主要原因是佐治亚州医疗补助参保儿童可获得的心理健康提供者短缺，这既源于现有心理健康提供者的工作量有限，也源于医疗补助参与率低，而非出行限制。增加提供者工作量和扩大医疗补助参与度可减少未满足的需求。增加工作量的干预措施是最有效的干预措施，因为现有的参与医疗补助的提供者在地理上已经有足够的网络覆盖。
