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Health care utilization by persons with severe and persistent mental illness
M R Berren1, J M Santiago, M R Zent
1Community Partnership of Southern Arizona, Tucson 85750, USA. miber@u.arizona.edu
Psychiatric Services (Washington, D.C.)
|April 22, 1999
Summary
Medicaid enrollees with severe mental illness had fewer overall physical health care claims but higher emergency room use. This indicates inefficient health care system utilization, emphasizing the need for care coordination.
Area of Science:
- Health Services Research
- Public Health
- Mental Health Services
Background:
- Individuals with severe mental illness (SMI) often experience fragmented healthcare.
- Understanding physical health care utilization patterns in SMI populations is crucial for effective resource allocation.
Purpose of the Study:
- To compare physical health care claims between Medicaid enrollees with SMI and those without.
- To identify differences in healthcare service utilization between these two groups.
Main Methods:
- Comparative analysis of health care claims data.
- Inclusion of 220 Medicaid enrollees with SMI and 166 controls without SMI.
- Examination of claim types including emergency room, ambulance, outpatient surgical, and outpatient hospital settings.
Main Results:
- The SMI group had 18% fewer total physical health care claims compared to the control group.
- Emergency room and ambulance services accounted for 28% of claims for the SMI group, versus 11% for controls.
- Outpatient surgical and hospital settings comprised 26% of claims for the control group, compared to 14% for the SMI group.
Conclusions:
- Mentally ill patients demonstrate inefficient use of the healthcare system.
- There is a significant need for improved care coordination for individuals with severe mental illness to optimize healthcare delivery and outcomes.