Enrollment in Medicare is associated with fewer outpatient mental healthcare visits among those with mental health symptoms.

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-12-30 DOI:10.1111/1475-6773.14423

Grace McCormack, Erin Duffy, Josephine Rohrer, Adam Biener

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引用次数: 0

Abstract

Objective: To test whether enrolling in traditional Medicare (TM) or Medicare Advantage (MA) at age 65 reduces mental healthcare utilization among individuals with mental health symptoms and low or moderate family incomes.

Study setting and design: We employ a fuzzy regression discontinuity design, comparing the likelihood of having an outpatient mental health visit or a psychotropic drug fill among individuals younger than or older than the age 65 Medicare eligibility threshold.

Data sources and analytic sample: We analyze 2014-2021 Medical Expenditure Panel Survey data. Our primary sample is restricted to individuals with probable mental health symptoms as indicated by their score on the Kessler K6 psychological distress scale (K6) and Patient Health Questionnaire-2 instrument (PHQ-2) and who have incomes less than 400% of the federal poverty level.

Principal findings: Among individuals with probable mental health symptoms and low or moderate incomes, enrolling in Medicare (combining the effect of MA and TM) is associated with a 24.9 percentage point reduction (95% CI -49.1 to -0.8; p = 0.043) in the likelihood of having any type of outpatient mental health visit and a 31.3 percentage point reduction (95% CI -54.2 to -8.4; p = 0.008) in the likelihood of having a prescription drug fill for a psychotropic drug. Effects of MA and TM on mental healthcare utilization are not statistically different from each other. We observe no impact of enrolling in Medicare on the likelihood of having a visit to a primary care provider, having a visit to a non-mental healthcare specialist, or having a fill for a prescribed non-psychotropic drug.

Conclusions: Enrolling in Medicare is associated with a reduction in the use of mental healthcare among individuals with probable mental health symptoms and low or moderate family incomes. Our findings suggest that the program poses access barriers specific to mental healthcare.

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在有心理健康症状的患者中，参加医疗保险与较少的门诊精神保健就诊有关。

目的：检验65岁参加传统医疗保险（TM）或医疗保险优势（MA）是否会降低有心理健康症状和家庭收入中低的个体的心理保健利用。研究设置和设计：我们采用模糊回归不连续设计，比较年龄小于或大于65岁医疗保险资格阈值的个体进行门诊心理健康访问或精神药物填充的可能性。数据来源和分析样本：我们分析2014-2021年医疗支出面板调查数据。我们的主要样本仅限于在凯斯勒K6心理困扰量表（K6）和患者健康问卷-2工具（PHQ-2）上得分显示可能有精神健康症状的个人，并且他们的收入低于联邦贫困水平的400%。主要发现：在可能有精神健康症状和低收入或中等收入的个体中，参加医疗保险（结合MA和TM的影响）与24.9个百分点的降低相关(95% CI -49.1至-0.8；p = 0.043)，任何类型的门诊心理健康访问的可能性降低了31.3个百分点(95% CI -54.2至-8.4；P = 0.008)，以处方药物代替精神药物的可能性。MA和TM对心理保健利用的影响差异无统计学意义。我们观察到，参加医疗保险对就诊初级保健提供者、非精神保健专家或服用处方非精神药物的可能性没有影响。结论：在可能有精神健康症状且家庭收入低或中等的个体中，参加医疗保险与使用精神保健的减少有关。我们的研究结果表明，该计划对精神保健造成了特定的准入障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.