National Healthcare Quality and Disparities Report
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Topics
- Access to Care (12)
- (-) Behavioral Health (28)
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- Substance Abuse (11)
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- Uninsured (1)
- Vulnerable Populations (1)
- Women (2)
- Young Adults (3)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 28 Research Studies DisplayedMeiselbach MK, Huskamp HA, Eddelbuettel JCP
Choice of high-deductible health plans among enrollees with a substance use disorder.
Researchers examined factors associated with the decision of individuals with substance use disorders (SUDs) to enroll in high-deductible health plans (HDHPs). They used de-identified administrative commercial claims and enrollment data from OptumLabs to identify individuals at employers that offered at least one HDHP and one non-HDHP plan. Their findings showed that a health reimbursement arrangement was associated with a higher probability of new and re-enrollment in an HDHP. Older enrollees with SUD were less likely to enroll in a new HDHP, while enrollees who were non-White, lower income, and in lower educational attainment census blocks were more likely to newly enroll. The researchers concluded that, given the emerging evidence that HDHPs may discourage SUD treatment, higher HDHP enrollment could exacerbate health disparities.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Huskamp HA, Eddelbuettel JCP .
Choice of high-deductible health plans among enrollees with a substance use disorder.
J Subst Use Addict Treat 2023 Nov; 154:209152. doi: 10.1016/j.josat.2023.209152.
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Keywords: Health Insurance, Substance Abuse, Behavioral Health
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance
Eliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, Health Insurance
Gertner AK, Rotter JS, Holly ME
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
This observational study’s goal was to determine if individuals newly diagnosed with opioid use disorder (OUD) who saw a primary care provider (PCP) before or on the date of diagnosis had higher rates of medication treatment for OUD (MOUD). Claims data from Medicaid and a large private insurer in North Carolina from January 2014 to July 2017 was used. During the period from 2014 to 2017, the prevalence of diagnosed OUD increased by 47% among Medicaid enrollees and by 76% among the privately insured. Over the same time period the number of people with an OUD who received MOUD fell among both groups, while PCP involvement in treatment increased. The percent of Medicaid enrollees receiving buprenorphine from a PCP increased from 32% in 2014 to 39% in 2017. In the 12 months before being newly diagnosed, approximately 82% with Medicaid or private insurance had a PCP visit. There was no difference in receiving an MOUD with those who had not seen a PCP. However, there was a higher probability of receiving MOUD with a PCP, than seeing an emergency provider, but lower than seeing a behavioral health specialist or other provider type.
AHRQ-funded; HS025065.
Citation: Gertner AK, Rotter JS, Holly ME .
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
J Addict Med 2022 Mar-Apr;16(2):183-91. doi: 10.1097/adm.0000000000000860..
Keywords: Primary Care, Opioids, Substance Abuse, Behavioral Health, Health Insurance
Friedman S, Xu H, Azocar F
Carve-out plan financial requirements associated with national behavioral health parity.
The authors examined changes in carve-out financial requirements following the Mental Health Parity and Addiction Equity Act (MHPAEA). They found that the MHPAEA was associated with increased generosity in most observed financial requirements, but increased use of deductibles may have reduced generosity for some patients.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Azocar F .
Carve-out plan financial requirements associated with national behavioral health parity.
Health Serv Res 2020 Dec;55(6):924-31. doi: 10.1111/1475-6773.13542..
Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Access to Care, Policy
Benson NM, Myong C, Newhouse JP
Psychiatrist participation in private health insurance markets: paucity in the land of plenty.
Using 2013 Massachusetts licensing data and the All-Payer Claims Database, researchers performed a cross-sectional analysis of licensed psychiatrists in Massachusetts to examine the extent of participation in private insurance. They found that, among Massachusetts psychiatrists, participation in the private insurance market appeared to be limited. Older psychiatrists were more likely to participate, and patients' access to psychiatrists who accept insurance could worsen as these psychiatrists retire.
AHRQ-funded; HS024725.
Citation: Benson NM, Myong C, Newhouse JP .
Psychiatrist participation in private health insurance markets: paucity in the land of plenty.
Psychiatr Serv 2020 Dec;71(12):1232-38. doi: 10.1176/appi.ps.202000022..
Keywords: Health Insurance, Behavioral Health, Access to Care, Provider: Physician, Provider
Fung V, Price M, Nierenberg AA
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
This study looked at outcomes from reducing behavioral health care Medicare coinsurance from 50% to 20% from 2009 to 2013. The sample of patients looked at included some diagnosed with SMI (serious mental illness) including schizophrenia, bipolar, or major depressive disorder). Data analysis was performed on 793,275 beneficiaries with SMI in 2008 and compared them with costs in 2013. The mean adjusted out-of-pocket costs for outpatient behavioral care decreased from $132 annually to $64, but the number of visits only increased slightly. No association was found between cost-sharing reductions and changes in behavioral health care visits.
AHRQ-funded; HS024725.
Citation: Fung V, Price M, Nierenberg AA .
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
JAMA Netw Open 2020 Oct;3(10):e2019854. doi: 10.1001/jamanetworkopen.2020.19854..
Keywords: Medicare, Health Insurance, Depression, Behavioral Health, Low-Income, Healthcare Costs, Healthcare Utilization
Zuvekas SH, McClellan CB, Ali MM
AHRQ Author: Zuvekas SH, McClellan CB
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
AHRQ-authored.
Citation: Zuvekas SH, McClellan CB, Ali MM .
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
J Ment Health Policy Econ 2020 Sep 1;23(3):151-82..
Keywords: Medical Expenditure Panel Survey (MEPS), Behavioral Health, Medicaid, Health Insurance, Access to Care, Healthcare Utilization, Policy, Uninsured
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Grafova IB, Monheit AC, Kumar R
How do changes in income, employment and health insurance affect family mental health spending?
This study used eight two-year panels from the MEPS data for 2004 to 2012 to examine the effect of economic shocks on mental health spending by families with children. Researchers wanted to determine whether the greatest impact on mental health spending comes from income, employment, or health insurance shocks. They used two-part expenditure models to estimate that employment losses are positively related to an increase in total family mental health expenditures. But no link was found between economic shocks and mental health spending on fathers.
AHRQ-funded; HS024053.
Citation: Grafova IB, Monheit AC, Kumar R .
How do changes in income, employment and health insurance affect family mental health spending?
Rev Econ Househ 2020 Mar;18(1:239-63. doi: 10.1007/s11150-018-9436-y.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Behavioral Health, Social Determinants of Health, Health Insurance
Mackie TI, Cook S, Crystal S
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
This study examined a multimodal antipsychotic intervention implemented by a specialized Medicaid managed care organization (MMCO) for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications. Findings showed that MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.
AHRQ-funded; HS026001.
Citation: Mackie TI, Cook S, Crystal S .
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
J Am Acad Child Adolesc Psychiatry 2020 Jan;59(1):166-76.e3. doi: 10.1016/j.jaac.2019.04.022..
Keywords: Children/Adolescents, Behavioral Health, Medication, Vulnerable Populations, Medicaid, Health Insurance
Olin S, Storfer-Isser A, Morden E
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
This study examined the performance of health plans on two Healthcare Effectiveness Data and Information Set (HEDIS) measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. This study then identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggested that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
ARHQ-funded; HS020503; HS025296.
Citation: Olin S, Storfer-Isser A, Morden E .
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
Psychiatr Serv 2019 Nov;70(11):1020-26. doi: 10.1176/appi.ps.201900089..
Keywords: Children/Adolescents, Medication, Behavioral Health, Quality Measures, Quality of Care, Health Insurance
Peterson E, Busch S
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
This article reviews the history and measures benefits from the 2008 passing of the Mental Health Parity and Addiction Equity Act (MHPAEA). It led to significant improvements in mental health care coverage. Directions for future research are also discussed.
AHRQ-funded; HS017589.
Citation: Peterson E, Busch S .
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
Annu Rev Public Health 2018 Apr 1;39:421-35. doi: 10.1146/annurev-publhealth-040617-013603..
Keywords: Access to Care, Behavioral Health, Disparities, Health Insurance, Policy, Substance Abuse
Kilbourne AM, Prenovost KM, Liebrecht C
Randomized controlled trial of a collaborative care intervention for mood disorders by a national commercial health plan.
This study investigated the outcomes of a collaborative care intervention for patients with mood disorders. The randomized controlled trial was conducted with Aetna insurance enrollees who were recently hospitalized for unipolar major depression or bipolar disorder. An evidence-based chronic care model (CCM) program was developed that included 10 sessions of a Life Goals self-management program and brief contacts were also made by a care manager. Outcomes measured were changes over 12 months in depression symptoms and mental health-related quality of life through two different short questionnaires. Clinical outcomes improved for patients receiving CCM although there was substantial attrition in the program.
AHRQ-funded; HS021425.
Citation: Kilbourne AM, Prenovost KM, Liebrecht C .
Randomized controlled trial of a collaborative care intervention for mood disorders by a national commercial health plan.
Psychiatr Serv 2019 Mar;70(3):219-24. doi: 10.1176/appi.ps.201800336..
Keywords: Depression, Behavioral Health, Health Insurance, Care Management, Teams, Healthcare Delivery
Fry CE, Sommers BD
Effect of Medicaid expansion on health insurance coverage and access to care among adults with depression.
This quasi-experimental study sought to determine the relationship between Medicaid expansion and various health and financial outcomes among low-income adults with depression. The investigators found that Medicaid expansion was associated with a significant reduction in the proportion of adults with depression who lacked health insurance. Medicaid expansion was also associated with significant reductions in delaying care and medications because of cost.
AHRQ-funded; HS021291.
Citation: Fry CE, Sommers BD .
Effect of Medicaid expansion on health insurance coverage and access to care among adults with depression.
Psychiatr Serv 2018 Nov;69(11):1146-52. doi: 10.1176/appi.ps.201800181..
Keywords: Access to Care, Depression, Health Insurance, Medicaid, Behavioral Health
Friedman SA, Azocar F, Xu H
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
The purpose of the stud was to assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e., copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services.
AHRQ-funded; HS024866.
Citation: Friedman SA, Azocar F, Xu H .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
Drug Alcohol Depend 2018 Sep 1;190:151-58. doi: 10.1016/j.drugalcdep.2018.06.008..
Keywords: Behavioral Health, Health Insurance, Policy, Substance Abuse
Andrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
AHRQ-funded; HS000084.
Citation: Andrews CM, Grogan CM, Smith BT .
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Schoenbaum M, Sutherland JM, Chappel A
AHRQ Author: Sutherland JM
Twelve-month health care use and mortality in commercially insured young people with incident psychosis in the United States.
This study assessed 12-month mortality and patterns of outpatient and inpatient treatment among young people experiencing an incident episode of psychosis in the United States. The hugely elevated mortality observed, when compared to the general population, underscores that young people experiencing psychosis warrant intensive clinical attention-yet the researchers found low rates of pharmacotherapy and limited use of psychosocial treatment.
AHRQ-authored.
Citation: Schoenbaum M, Sutherland JM, Chappel A .
Twelve-month health care use and mortality in commercially insured young people with incident psychosis in the United States.
Schizophr Bull 2017 Oct;43(6):1262-72. doi: 10.1093/schbul/sbx009.
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Keywords: Healthcare Utilization, Health Insurance, Health Services Research (HSR), Behavioral Health, Young Adults
Friedman S, Xu H, Harwood JM
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
The purpose of this study was to determine whether Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with increased behavioral health expenditures and utilization among a population with substance use disorder (SUD) diagnoses. The investigators found that MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Harwood JM .
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
J Subst Abuse Treat 2017 Sep;80:67-78. doi: 10.1016/j.jsat.2017.06.006..
Keywords: Behavioral Health, Healthcare Costs, Healthcare Utilization, Health Insurance, Policy, Health Services Research (HSR), Substance Abuse
Thalmayer AG, Friedman SA, Azocar F
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: impact on quantitative treatment limits.
This study assessed Mental Health Parity and Addiction Equity Act’s (MHPAEA) effect on the prevalence of behavioral health quantitative treatment limits (QTLs). It concluded that, before MHPAEA, QTLs were common. Postimplementation, virtually all plans dropped such limits, suggesting that MHPAEA was effective at eliminating QTLs.
AHRQ-funded; HS024866.
Citation: Thalmayer AG, Friedman SA, Azocar F .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: impact on quantitative treatment limits.
Psychiatr Serv 2017 May;68(5):435-42. doi: 10.1176/appi.ps.201600110.
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Keywords: Access to Care, Health Insurance, Policy, Behavioral Health
Ali MM, Chen J, Mutter R
AHRQ Author: Novak P
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
The authors analyzed out-of-pocket spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. They found that the extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
AHRQ-authored.
Citation: Ali MM, Chen J, Mutter R .
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
Psychiatr Serv 2016 Sep;67(9):977-82. doi: 10.1176/appi.ps.201500346.
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Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Young Adults
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
AHRQ-funded; HS021486.
Citation: Creedon TB, Cook BL .
Access to mental health care increased but not for substance use, while disparities remain.
Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
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Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Montz E, Layton T, Busch AB
Risk-adjustment simulation: plans may have incentives to distort mental health and substance use coverage.
The authors examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. They documented how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders.
AHRQ-funded; HS000055.
Citation: Montz E, Layton T, Busch AB .
Risk-adjustment simulation: plans may have incentives to distort mental health and substance use coverage.
Health Aff 2016 Jun;35(6):1022-8. doi: 10.1377/hlthaff.2015.1668.
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Keywords: Health Insurance, Policy, Behavioral Health, Substance Abuse