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Wise A, Kianian B, Chang HH, Linton S, Wolfe ME, Smith J, Tempalski B, Jarlais DD, Ross Z, Semaan S, Wejnert C, Broz D, Cooper HLF. Is the severity of the Great Recession's aftershocks correlated with changes in access to the combined prevention environment among people who inject drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103264. [PMID: 33990058 PMCID: PMC11091490 DOI: 10.1016/j.drugpo.2021.103264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. METHODS The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. RESULTS 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. CONCLUSION Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
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Affiliation(s)
- Akilah Wise
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Behzad Kianian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sabriya Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E Wolfe
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, USA
| | - Don Des Jarlais
- College of Global Public Health, New York University, New York, NY, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hung M, Lipsky MS, Moffat R, Lauren E, Hon ES, Park J, Gill G, Xu J, Peralta L, Cheever J, Prince D, Barton T, Bayliss N, Boyack W, Licari FW. Health and dental care expenditures in the United States from 1996 to 2016. PLoS One 2020; 15:e0234459. [PMID: 32526770 PMCID: PMC7289437 DOI: 10.1371/journal.pone.0234459] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/08/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction As total health and dental care expenditures in the United States continue to rise, healthcare disparities for low to middle-income Americans creates an imperative to analyze existing expenditures. This study examined health and dental care expenditures in the United States from 1996 to 2016 and explored trends in spending across various population subgroups. Methods Using data collected by the Medical Expenditure Panel Survey, this study examined health and dental care expenditures in the United States from 1996 to 2016. Trends in spending were displayed graphically and spending across subgroups examined. All expenditures were adjusted for inflation or deflation to the 2016 dollar. Results Both total health and dental expenditures increased between 1996 and 2016 with total healthcare expenditures increasing from $838.33 billion in 1996 to $1.62 trillion in 2016, a 1.9-fold increase. Despite an overall increase, total expenditures slowed between 2004 and 2012 with the exception of the older adult population. Over the study period, expenditures increased across all groups with the greatest increases seen in older adult health and dental care. The per capita geriatric dental care expenditure increased 59% while the per capita geriatric healthcare expenditure increased 50% across the two decades. For the overall US population, the per capita dental care expenditure increased 27% while the per capita healthcare expenditure increased 60% over the two decades. All groups except the uninsured experienced increased dental care expenditure over the study period. Conclusions Healthcare spending is not inherently bad since it brings benefits while exacting costs. Our findings indicate that while there were increases in both health and dental care expenditures from 1996 to 2016, these increases were non-uniform both across population subgroups and time. Further research to understand these trends in detail will be helpful to develop strategies to address health and dental care disparities and to maximize resource utilization.
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Affiliation(s)
- Man Hung
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
- University of Utah School of Medicine, South Jordan, UT, United States of America
- University of Utah School of Business, South Jordan, UT, United States of America
- University of Utah College of Education, South Jordan, UT, United States of America
- Towson University Department of Occupational Therapy & Occupational Science, Towson, MD, United States of America
- * E-mail:
| | - Martin S. Lipsky
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
- Portland State University College of Urban & Public Affairs, Portland, OR, United States of America
| | - Ryan Moffat
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - Evelyn Lauren
- Boston University Department of Biostatistics, Boston, MA, United States of America
| | - Eric S. Hon
- University of Chicago Department of Economics, Chicago, IL, United States of America
| | - Jungweon Park
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - Gagandeep Gill
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - Julie Xu
- University of Utah School of Medicine, South Jordan, UT, United States of America
| | - Lourdes Peralta
- University of Utah School of Medicine, South Jordan, UT, United States of America
| | - Joseph Cheever
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - David Prince
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - Tanner Barton
- University of Utah School of Medicine, South Jordan, UT, United States of America
| | - Nicole Bayliss
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - Weston Boyack
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
| | - Frank W. Licari
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, United States of America
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3
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Mulvaney-Day N, Gibbons BJ, Alikhan S, Karakus M. Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. Am J Public Health 2019; 109:S190-S196. [PMID: 31242013 DOI: 10.2105/ajph.2019.305023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the impact of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) on mental and substance use disorder services in the private, large group employer-sponsored insurance market in the United States. Methods. We analyzed data from the IBM MarketScan Commercial Database from January 2005 through September 2015 by using population-level interrupted time series regressions to determine whether parity implementation was associated with utilization and spending outcomes. Results. MHPAEA had significant positive associations with utilization of mental and substance use disorder outpatient services. A spending decomposition analysis indicated that increases in utilization were the primary drivers of increases in spending associated with MHPAEA. Analyses of opioid use disorder and nonopioid substance use disorder services found that associations with utilization and spending were not attributable only to increases in treatment of opioid use disorder. Conclusions. MHPAEA is positively associated with utilization of outpatient mental and substance use disorder services for Americans covered by large group employer-sponsored insurance. Public Health Implications. These trends continued over the 5-year post-MHPAEA period, underscoring the long-term relationship between this policy change and utilization of behavioral health services.
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Affiliation(s)
- Norah Mulvaney-Day
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Brent J Gibbons
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Shums Alikhan
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Mustafa Karakus
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
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Lo-Ciganic WH, Donohue JM, Kim JY, Krans EE, Jones BL, Kelley D, James AE, Jarlenski MP. Adherence trajectories of buprenorphine therapy among pregnant women in a large state Medicaid program in the United States. Pharmacoepidemiol Drug Saf 2018; 28:80-89. [PMID: 30192041 DOI: 10.1002/pds.4647] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 07/22/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Little is known about the longitudinal patterns of buprenorphine adherence among pregnant women with opioid use disorder, especially when late initiation, nonadherence, or early discontinuation of buprenorphine during pregnancy may increase the risk of adverse outcomes. We aimed to identify distinct trajectories of buprenorphine use during pregnancy, and factors associated with these trajectories in Medicaid-enrolled pregnant women. METHODS A retrospective cohort study included 2361 Pennsylvania Medicaid enrollees aged 15 to 46 having buprenorphine therapy during pregnancy and a live birth between 2008 and 2015. We used group-based trajectory models to identify buprenorphine use patterns in the 40 weeks prior to delivery and 12 weeks postdelivery. Multivariable multinomial logistic regression models were used to identify factors associated with specific trajectories. RESULTS Six distinct trajectories were identified. Four groups initiated buprenorphine during the first trimester of the pregnancy (early initiators): 31.6% with persistently high adherence, 15.1% with moderate-to-high adherence, 10.5% with declining adherence, and 16.7% with early discontinuation. Two groups did not initiate buprenorphine until midsecond or third trimester (late initiators): 13.5% had moderate-to-high adherence and 12.6% had low-to-moderate adherence. Factors significantly associated with late initiation and discontinuation were younger age, non-white race, residents of rural counties, fewer outpatient visits, more frequent emergency department visits and hospitalizations, and lower buprenorphine daily dose. CONCLUSIONS Six buprenorphine treatment trajectories during pregnancy were identified in this population-based Medicaid cohort, with 25% of women initiating buprenorphine late during pregnancy. Understanding trajectories of buprenorphine use and factors associated with discontinuation/nonadherence may guide integration of behavioral treatment with obstetrical/gynecological care to improve buprenorphine treatment during pregnancy.
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Affiliation(s)
- Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Julie M Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joo Yeon Kim
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Bobby L Jones
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Kelley
- Pennsylvania Department of Human Services, Harrisburg, PA, USA
| | - Alton E James
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marian P Jarlenski
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Projected Spending on Psychotropic Medications 2013-2020. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:497-505. [PMID: 26041078 DOI: 10.1007/s10488-015-0661-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spending on psychotropic medications has grown rapidly in recent decades. Using national data on drug expenditures, patent expirations, future drug development and expert interviews, we project that spending will grow more slowly over the period 2012-2020. The average annual increase is projected to be just 3.0 % per year, continuing the steady deceleration in recent years. The main drivers of this expected deceleration include slower development of new drugs, upcoming patent expirations which will lower prices, and payers' growing ability to manage utilization and promote generic use. The slowdown will relieve some cost pressures on payers, particularly Medicare and Medicaid.
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Cantor J, Stoller KB, Saloner B. The response of substance use disorder treatment providers to changes in macroeconomic conditions. J Subst Abuse Treat 2017; 81:59-65. [PMID: 28847456 DOI: 10.1016/j.jsat.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study how substance use disorder (SUD) treatment providers respond to changes in economic conditions. DATA SOURCES 2000-2012 National Survey of Substance Abuse Treatment Services (N-SSATS) which contains detailed information on specialty SUD facilities in the United States. STUDY DESIGN We use fixed-effects regression to study how changes in economic conditions, proxied by state unemployment rates, impact treatment setting, accepted payment forms, charity care, offered services, special programs, and use of pharmacotherapies by specialty SUD treatment providers. DATA COLLECTION Secondary data analysis in the N-SSATS. PRINCIPAL FINDINGS Our findings suggest a one percentage point increase in the state unemployment rate is associated with a 2.5% reduction in outpatient clients by non-profit providers and a 1.8% increase in the acceptance of private insurance as a form of payment overall. We find no evidence that inpatient treatment, the provision of charity care, offered services, or special programs are impacted by changes in the state unemployment rate. However, a one percentage point increase in the state unemployment rate leads to a 2.5% increase in the probability that a provider uses pharmacotherapies to treat addiction. CONCLUSIONS Deteriorating economic conditions may increase financial pressures on treatment providers, prompting them to seek new sources of revenue or to change their care delivery models.
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Affiliation(s)
- Jonathan Cantor
- Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette St, New York, NY 10012, USA.
| | - Kenneth B Stoller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 911 North Broadway, Baltimore, MD 21205, USA.
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 344, Baltimore, MD 21205, USA.
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7
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Chen J, Dagher R. Gender and Race/Ethnicity Differences in Mental Health Care Use before and during the Great Recession. J Behav Health Serv Res 2017; 43:187-99. [PMID: 24699888 DOI: 10.1007/s11414-014-9403-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the changes in health care utilization for mental health disorders among patients who were diagnosed with depressive and/or anxiety disorders during the Great Recession 2007-2009 in the USA. Negative binomial regressions are used to estimate the association of the economic recession and mental health care use for females and males separately. Results show that prescription drug utilization (e.g., antidepressants, psychotropic medications) increased significantly during the economic recession 2007-2009 for both females and males. Physician visits for mental health disorders decreased during the same period. Results show that racial disparities in mental health care might have increased, while ethnic disparities persisted during the Great Recession. Future research should separately examine mental health care utilization by gender and race/ethnicity.
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Affiliation(s)
- Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, 3310A School of Public Health Building, College Park, MD, 20742-2611, USA.
| | - Rada Dagher
- Department of Health Services Administration, School of Public Health, University of Maryland, 3310B School of Public Health Building, College Park, MD, 20742-2611, USA
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8
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Cook BL, Trinh NH, Li Z, Hou SSY, Progovac AM. Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012. Psychiatr Serv 2017; 68:9-16. [PMID: 27476805 PMCID: PMC5895177 DOI: 10.1176/appi.ps.201500453] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study compared trends in racial-ethnic disparities in mental health care access among whites, blacks, Hispanics, and Asians by using the Institute of Medicine definition of disparities as all differences except those due to clinical appropriateness, clinical need, and patient preferences. METHODS Racial-ethnic disparities in mental health care access were examined by using data from a nationally representative sample of 214,597 adults from the 2004-2012 Medical Expenditure Panel Surveys. The main outcome measures included three mental health care access measures (use of any mental health care, any outpatient care, and any psychotropic medication in the past year). RESULTS Significant disparities were found in 2004-2005 and in 2011-2012 for all three racial-ethnic minority groups compared with whites in all three measures of access. Between 2004 and 2012, black-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.2% to 10.8% and from 7.6% to 10.0%. Similarly, Hispanic-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.4% to 10.9% and 7.3% to 10.3%. CONCLUSIONS No reductions in racial-ethnic disparities in access to mental health care were identified between 2004 and 2012. For blacks and Hispanics, disparities were exacerbated over this period. Clinical interventions that improve identification of symptoms of mental illness, expansion of health insurance, and other policy interventions that remove financial barriers to access may help to reduce these disparities.
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Affiliation(s)
- Benjamin Lê Cook
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Nhi-Ha Trinh
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Zhihui Li
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Sherry Shu-Yeu Hou
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Ana M Progovac
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
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Andrews C, Grogan CM, Brennan M, Pollack HA. Lessons From Medicaid's Divergent Paths On Mental Health And Addiction Services. Health Aff (Millwood) 2016; 34:1131-8. [PMID: 26153307 DOI: 10.1377/hlthaff.2015.0151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the past fifty years Medicaid has taken divergent paths in financing mental health and addiction treatment. In mental health, Medicaid became the dominant source of funding and had a profound impact on the organization and delivery of services. But it played a much more modest role in addiction treatment. This is poised to change, as the Affordable Care Act is expected to dramatically expand Medicaid's role in financing addiction services. In this article we consider the different paths these two treatment systems have taken since 1965 and identify strategic lessons that the addiction treatment system might take from mental health's experience under Medicaid. These lessons include leveraging optional coverage categories to tailor Medicaid to the unique needs of the addiction treatment system, providing incentives to addiction treatment programs to create and deliver high-quality alternatives to inpatient treatment, and using targeted Medicaid licensure standards to increase the quality of addiction services.
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Affiliation(s)
- Christina Andrews
- Christina Andrews is an assistant professor in the College of Social Work, University of South Carolina, in Columbia
| | - Colleen M Grogan
- Colleen M. Grogan is a professor in the School of Social Service Administration, University of Chicago, in Illinois
| | - Marianne Brennan
- Marianne Brennan is a doctoral student in the School of Social Service Administration, University of Chicago
| | - Harold A Pollack
- Harold A. Pollack is a professor in the School of Social Service Administration, University of Chicago
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10
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Mullins PM, Mazer-Amirshahi M, Pines JM. Alcohol-Related Visits to US Emergency Departments, 2001-2011. Alcohol Alcohol 2016; 52:119-125. [PMID: 27998923 DOI: 10.1093/alcalc/agw074] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Alcohol intoxication is a source of significant illness and injury commonly resulting in emergency department (ED) visits. We characterize recent trends in alcohol-related visits to US EDs using nationally representative data. METHODS We conducted a retrospective review of data on national ED visits among patients aged 18 years or older with alcohol intoxication between 2001 and 2011 using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Demographic and resource utilization trends in alcohol-related visits were examined. We also assessed ED length of stay (LOS) across the study period, as well as the total hours spent on ED care for alcohol-related complaints. RESULTS Between 2001-2002 and 2010-2011, alcohol-related visits increased from 2,459,748 to 3,856,346 (P = 0.049). Utilization of resources such as laboratory tests, medications and radiography increased, with the use of advanced imaging (i.e. computed tomography and magnetic resonance imaging) increasing 232.2% (P < 0.001) from 2001-2002 to 2010-2011. Overall LOS increased 16.1% (P = 0.028), while LOS among patients admitted to the hospital increased 24.9% (P = 0.076). Total alcohol-related hours spent in EDs nationwide increased from 5.6 million in 2001 to 11.6 million in 2011, an increase of 108.5% (P < 0.001) compared with an increase in overall ED hours of 54.0% (P < 0.001). CONCLUSION Alcohol-related ED visits are increasing at a greater rate than overall ED visits and represent a growing burden on hospital resources.
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Affiliation(s)
- Peter M Mullins
- Center for Healthcare Innovation and Policy Research, School of Medicine and Health Sciences, The George Washington University, 2100 Pennsylvania Ave, Suite 300, Washington, DC 20037, USA
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, Medstar Washington Hospital Center, 110 Irving Street NW, Suite NA 1177, Washington, DC 20010, USA
| | - Jesse M Pines
- Center for Healthcare Innovation and Policy Research, School of Medicine and Health Sciences, The George Washington University, 2100 Pennsylvania Ave, Suite 300, Washington, DC 20037, USA.,Departments of Emergency Medicine and Health Policy and Management, The George Washington University, 2100 Pennsylvania Ave, Suite 300, Washington, DC 20037, USA
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11
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Mark TL, Levit KR, Yee T, Chow CM. Spending on mental and substance use disorders projected to grow more slowly than all health spending through 2020. Health Aff (Millwood) 2016; 33:1407-15. [PMID: 25092843 DOI: 10.1377/hlthaff.2014.0163] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.3 trillion) to 6.5 percent in 2020 ($281 billion out of $4.3 trillion). This trend is the projected result of reduced spending on mental health drugs because of patent expirations, the low likelihood of innovative drugs entering the market, and a slowdown in spending growth for hospital treatment. By 2020 the expansion of coverage to previously uninsured Americans under the Affordable Care Act (ACA), combined with the projected slowdown in Medicare provider payment rates under the ACA and the Budget Control Act of 2011, are expected to add 2.7 percent to behavioral health spending, compared to spending without these changes.
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Affiliation(s)
- Tami L Mark
- Tami L. Mark is a vice president at Truven Health Analytics in Bethesda, Maryland
| | | | - Tracy Yee
- Tracy Yee is a research leader at Truven Health Analytics
| | - Clifton M Chow
- Clifton M. Chow is a research leader at Truven Health Analytics
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Mark TL, Yee T, Levit KR, Camacho-Cook J, Cutler E, Carroll CD. Insurance Financing Increased For Mental Health Conditions But Not For Substance Use Disorders, 1986–2014. Health Aff (Millwood) 2016; 35:958-65. [DOI: 10.1377/hlthaff.2016.0002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tami L. Mark
- Tami L. Mark ( ) is vice president of the Evaluation and Economic Research Division of Truven Health Analytics, an IBM company, in Bethesda, Maryland
| | - Tracy Yee
- Tracy Yee is a research leader at Truven Health Analytics in Bethesda
| | - Katharine R. Levit
- Katharine R. Levit is a consultant with Truven Health Analytics in Bethesda
| | - Jessica Camacho-Cook
- Jessica Camacho-Cook is a senior business analyst at Truven Health Analytics in Bethesda
| | - Eli Cutler
- Eli Cutler is a senior research analyst at Truven Health Analytics in Cambridge, Massachusetts
| | - Christopher D. Carroll
- Christopher D. Carroll is director of health care financing and systems integration at the Substance Abuse and Mental Health Services Administration, in Rockville, Maryland
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Martin-Carrasco M, Evans-Lacko S, Dom G, Christodoulou NG, Samochowiec J, González-Fraile E, Bienkowski P, Gómez-Beneyto M, Dos Santos MJH, Wasserman D. EPA guidance on mental health and economic crises in Europe. Eur Arch Psychiatry Clin Neurosci 2016; 266:89-124. [PMID: 26874960 DOI: 10.1007/s00406-016-0681-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/28/2016] [Indexed: 12/16/2022]
Abstract
This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.
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Affiliation(s)
- M Martin-Carrasco
- Institute of Psychiatric Research, Mª Josefa Recio Foundation (Hospitaller Sisters), Bilbao, Spain. .,Centro de Investigación en Red Salud Mental (CIBERSAM), Madrid, Spain. .,Clinica Padre Menni, Department of Psychiatry, Joaquin Beunza, 45, 31014, Pamplona, Spain.
| | - S Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.,PSSRU, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - G Dom
- Collaborative Antwerp Psychiatric Research Institute, Antwerp University, 2610, Wilrijk, Belgium
| | | | - J Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - E González-Fraile
- Institute of Psychiatric Research, Mª Josefa Recio Foundation (Hospitaller Sisters), Bilbao, Spain
| | - P Bienkowski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M Gómez-Beneyto
- Centro de Investigación en Red Salud Mental (CIBERSAM), Madrid, Spain.,University of Valencia, Valencia, Spain
| | - M J H Dos Santos
- Portuguese Society of Psychiatry and Mental Health, Beatriz Ângelo Hospital, Lisbon, Portugal
| | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental Health, Karolinska Institute, Stockholm, Sweden
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Thomas CP, Hodgkin D, Levit K, Mark TL. Growth in spending on substance use disorder treatment services for the privately insured population. Drug Alcohol Depend 2016; 160:143-50. [PMID: 26781063 DOI: 10.1016/j.drugalcdep.2015.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 12/21/2015] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 8% of individuals with private health insurance in the United States have substance use disorders (SUDs), but in 2009 only 0.4% of all private insurance spending was on SUDs. The objective of this study was to determine if changes that occurred between 2009 and 2012 - such as more generous SUD benefits, an epidemic of opioid use disorders, and slow recovery from a recession - were associated with greater use of SUD treatment. METHODS Data were from the 2004-2012 Truven Health Analytics MarketScan(®) Commercial Claims and Encounters Database. This database is representative of individuals with private insurance in the United States. Per enrollee use of and spending on SUD treatment was determined and compared with spending on all health care services. Trends were examined for inpatient care, outpatient care, and prescription medications. RESULTS During the 2009-2012 time period, use of and spending on SUD services increased compared with all diagnoses. Two-thirds of the increase was driven by higher growth rates in outpatient use and prices. Despite the high growth rates, SUD treatment penetration rates remained low. As of 2012, only 0.6% of individuals with private insurance used SUD outpatient services, 0.2% filled SUD medication prescriptions, and 0.1% used inpatient SUD services. In 2012, SUD services accounted for less than 0.7% of all private insurance spending. CONCLUSIONS Despite recent coverage improvements, individuals with private health insurance still may not receive adequate levels of treatment for SUDs, as evidenced by the small proportion of individuals who access treatment.
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Affiliation(s)
- Cindy Parks Thomas
- Schneider Institutes for Health Policy, Brandeis University, 415 South Street (MS 035), Waltham, MA 02454-9110, United States.
| | - Dominic Hodgkin
- Schneider Institutes for Health Policy, Brandeis University, 415 South Street (MS 035), Waltham, MA 02454-9110, United States.
| | - Katharine Levit
- Truven Health Analytics, 7700 Old Georgetown Road, Suite 650, Bethesda, MD 20814-6243, United States.
| | - Tami L Mark
- Truven Health Analytics, 7700 Old Georgetown Road, Suite 650, Bethesda, MD 20814-6243, United States.
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Burns RM, Pacula RL, Bauhoff S, Gordon AJ, Hendrikson H, Leslie DL, Stein BD. Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013. Subst Abus 2015; 37:63-9. [PMID: 26566761 DOI: 10.1080/08897077.2015.1080208] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND State Medicaid policies play an important role in Medicaid enrollees' access to and use of opioid agonists, such as methadone and buprenorphine, in the treatment of opioid use disorders. Little information is available, however, regarding the evolution of state policies facilitating or hindering access to opioid agonists among Medicaid enrollees. METHODS During 2013-2014, we surveyed state Medicaid officials and other designated state substance abuse treatment specialists about their state's recent history of Medicaid coverage and policies pertaining to methadone and buprenorphine. We describe the evolution of such coverage and policies and present an overview of the Medicaid policy environment with respect to opioid agonist therapy from 2004 to 2013. RESULTS Among our sample of 45 states with information on buprenorphine and methadone coverage, we found a gradual trend toward adoption of coverage for opioid agonist therapies in state Medicaid agencies. In 2013, only 11% of states in our sample (n = 5) had Medicaid policies that excluded coverage for methadone and buprenorphine, whereas 71% (n = 32) had adopted or maintained policies to cover both buprenorphine and methadone among Medicaid enrollees. We also noted an increase in policies over the time period that may have hindered access to buprenorphine and/or methadone. CONCLUSIONS There appears to be a trend for states to enact policies increasing Medicaid coverage of opioid agonist therapies, while in recent years also enacting policies, such as prior authorization requirements, that potentially serve as barriers to opioid agonist therapy utilization. Greater empirical information about the potential benefits and potential unintended consequences of such policies can provide policymakers and others with a more informed understanding of their policy decisions.
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Affiliation(s)
| | | | | | - Adam J Gordon
- b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.,c Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Hollie Hendrikson
- d National Conference of State Legislatures , Denver , Colorado , USA
| | | | - Bradley D Stein
- a RAND Corporation , Pittsburgh , Pennsylvania , USA.,b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
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Shah GH, Luo H, Winterbauer N, Madamala K. Addressing psychological, mental health and other behavioural healthcare needs of the underserved populations in the United States: the role of local health departments. Perspect Public Health 2015; 136:86-92. [DOI: 10.1177/1757913915597960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: (1) To assess the extent to which local health departments (LHDs) implement and evaluate strategies to target the behavioural healthcare needs for the underserved populations and (2) to identify factors that are associated with these undertakings. Methods: Data for this study were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials. A total of 505 LHDs completed the Module 2 questionnaire of the Profile Study, in which LHDs were asked whether they implemented strategies and evaluated strategies to target the behavioural healthcare needs of the underserved populations. To assess LHDs’ level of engagement in assuring access to behavioural healthcare services, descriptive statistics were computed, whereas the factors associated with assuring access to these services were examined by using logistic regression analyses. To account for complex survey design, we used SVY routine in Stata 11. Results: Only about 24.9% of LHDs in small jurisdiction (<50,000 population) and 35.3% of LHDs in medium-size jurisdiction implemented/evaluated strategies to target the behavioural healthcare services needs of underserved populations in their jurisdiction in 2013. Logistic regression model results showed that LHDs having city/multicity jurisdiction (adjusted odds ratio (AOR) = .16, 95% confidence interval (CI): .04–.77), centralised governance (AOR = .12, 95% CI: .02–.85), and those located in South Region (AOR = .25, 95% CI: .08–.74) or the West Region (AOR = .36, 95% CI: 14–.94), were less likely to have implemented/evaluated strategies to target the behavioural healthcare needs of the underserved. Conclusions: The extent to which the LHDs implemented or evaluated strategies to target the behavioural healthcare needs of the underserved population varied by geographic regions and jurisdiction types. Different community needs or different state Medicaid programmes may have accounted for these variations. LHDs could play an important role in improving equity in access to care, including behavioural healthcare services in the communities.
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Affiliation(s)
- Gulzar H Shah
- Associate Dean of Research, Associate Professor of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, USA
| | - Huabin Luo
- Assistant Professor, East Carolina University, Greenville, NC, USA
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Dick AW, Pacula RL, Gordon AJ, Sorbero M, Burns RM, Leslie D, Stein BD. Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002-11. Health Aff (Millwood) 2015; 34:1028-34. [PMID: 26056209 PMCID: PMC4743254 DOI: 10.1377/hlthaff.2014.1205] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Opioid use disorders are a significant public health problem, affecting two million people in the United States. Treatment with buprenorphine, methadone, or both is predominantly offered in methadone clinics, yet many people do not receive the treatment they need. In 2002 the Food and Drug Administration approved buprenorphine for prescription by physicians who completed a course and received a waiver from the Drug Enforcement Administration, exempting them from requirements in the Controlled Substances Act. To determine the waiver program's impact on the availability of opioid agonist treatment, we analyzed data for the period 2002-11 to identify counties with opioid treatment shortages. We found that the percentage of counties with a shortage of waivered physicians fell sharply, from 98.9 percent in 2002 to 46.8 percent in 2011. As a result, the percentage of the US population residing in what we classified as opioid treatment shortage counties declined from 48.6 percent in 2002 to 10.4 percent in 2011. These findings suggest that the increase in waivered physicians has dramatically increased potential access to opioid agonist treatment. Policy makers should focus their efforts on further increasing the number and geographical distribution of physicians, particularly in more rural counties, where prescription opioid misuse is rapidly growing.
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Affiliation(s)
- Andrew W Dick
- Andrew W. Dick is a senior economist at the RAND Corporation in Boston, Massachusetts
| | - Rosalie L Pacula
- Rosalie L. Pacula is a senior economist at RAND in Santa Monica, California
| | - Adam J Gordon
- Adam J. Gordon is an associate professor of medicine at the University of Pittsburgh School of Medicine and a staff physician in the Veterans Affairs Pittsburgh Healthcare System
| | - Mark Sorbero
- Mark Sorbero is a project associate at RAND in Pittsburgh
| | - Rachel M Burns
- Rachel M. Burns is a project associate at RAND in Pittsburgh
| | - Douglas Leslie
- Douglas Leslie is a professor of public health sciences and psychiatry at the Penn State College of Medicine
| | - Bradley D Stein
- Bradley D. Stein is a senior natural scientist at RAND in Pittsburgh and an adjunct professor of psychiatry at the University of Pittsburgh School of Medicine
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Dagher RK, Chen J, Thomas SB. Gender Differences in Mental Health Outcomes before, during, and after the Great Recession. PLoS One 2015; 10:e0124103. [PMID: 25970634 PMCID: PMC4430539 DOI: 10.1371/journal.pone.0124103] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/25/2015] [Indexed: 12/03/2022] Open
Abstract
We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities.
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Affiliation(s)
- Rada K. Dagher
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Stephen B. Thomas
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland, United States of America
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Abstract
The American populace currently supports the need for providing additional mental health services for adolescents who frequently express anger and mood instability and maybe are at risk for major psychiatric disorders and behavioral problems; Vietnam, Iraqi, and Afghanistan veterans or military personnel still on duty diagnosed with posttraumatic stress disorder, depression, or other similar combat-related disabilities; the approximately 1 million prisoners currently incarcerated primarily because of substance abuse and needing medically related rehabilitative services; and senior citizens who experience dementia and depression and require improved therapeutics. The problems outlined herein are as follows: far too limited monies are being spent for mental health services (5.6% of total US expenditures for health or roughly one fifth of what is consumed for hospital care); effective therapies are often lacking; and there is a shortage of qualified mental health personnel except in upscale urban and suburban areas. Unfortunately, these problems are so immense that, even with enhanced prioritization of our available resources, they are still not entirely solvable. The American public may continue to impart lip service when attempting to respond to our nation's mental health needs or may decide to spend vastly more money for such care. The latter choice may not be forthcoming in the near future for various cultural-societal-clinical-fiscal reasons.
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Carson NJ, Vesper A, Chen CN, Lê Cook B. Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups. Psychiatr Serv 2014; 65:888-96. [PMID: 24686538 PMCID: PMC4182296 DOI: 10.1176/appi.ps.201300139] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States. METHODS The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference. RESULTS Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge. CONCLUSIONS Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.
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Affiliation(s)
- Nicholas J Carson
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Andrew Vesper
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Chih-Nan Chen
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Benjamin Lê Cook
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
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Modrek S, Stuckler D, McKee M, Cullen MR, Basu S. A Review of Health Consequences of Recessions Internationally and a Synthesis of the US Response during the Great Recession. Public Health Rev 2013. [DOI: 10.1007/bf03391695] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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