Statewide health care reform in Massachusetts did not increase inpatient admissions for behavioral diagnoses among adolescents and young adults, as some had feared. Instead, reform led to a decrease in such admissions, a report published online Feb. 19 in JAMA Psychiatry showed.
This suggests nationwide health care reform might have a similar effect, at least in states that, like Massachusetts, offer robust hospital-based mental health services.
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The findings are reassuring in that they appear to show that young people with behavioral health issues will now find the care they need to be more accessible and affordable, without increasing the burden on hospitals or raising inpatient costs, the authors said.
One major goal of health care reform is to extend insurance coverage to populations least likely to have it, such as young adults. Given that most behavioral health disorders emerge in adolescence and young adulthood, some experts were concerned that newly acquired insurance coverage for this age group might lead to increases in hospital and emergency department admissions for behavioral issues, said Ellen Meara, Ph.D., of the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., and her associates.
To assess whether the enactment of national health care reform might lead to a sharp increase in such hospital and ED admissions, the investigators examined the experience in Massachusetts after statewide health care reform was enacted there in 2006.
They analyzed the records of 2,533,307 admissions for any diagnosis and 6,817,855 ED visits for any diagnosis and focused on young adults aged 19-25 years – "a group with relatively high behavioral health needs and low rates of insurance coverage prior to reform" (JAMA Psychiatry 2014 Feb. 19 [doi:10.1001/jamapsychiatry.2013.3972]).
Dr. Meara and her associates found that the uninsured rate fell from 26% to 10% among this population after health reform. The increase in insurance coverage was accompanied by a decline in patient admission rates and ED visits for young adults with behavioral health diagnoses. The drop was fueled primarily by a decrease in admissions and ED visits for substance use disorders. This pattern suggests that most of these patients are being redirected – appropriately – to outpatient services, Dr. Meara and her associates said.
The findings are reassuring in that they appear to show that young people with behavioral health issues will now find the care they need to be more accessible and affordable, without increasing the burden on hospitals or raising inpatient costs, they said.
Dr. Meara and her associates cited a few limitations. For example, outpatient treatment for mental illness or substance use disorders was not observed. "Thus, we cannot infer whether use of hospital-based care for mental illness and substance use disorders represents lower rates of morbidity in the population, effective care in outpatient settings, or restrictions on use of hospital-based settings," they wrote. In addition, they did not look at admissions to psychiatric or alcohol or chemical-dependency facilities.
Still, the data "offer a snapshot of one aspect of policies to improve access to behavioral health treatment, expanded insurance coverage," they said.
The study was supported by the National Institutes of Health and the National Institute of Drug Abuse. No financial conflicts of interest were reported.