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Service system finance: implications for children with depression and manic depression

S Glied1, A Neufeld

  • 1Division of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.

Biological Psychiatry
|June 30, 2001
PubMed

Insights

Approximately 6.2% of US children have depression, yet many lack treatment. Service system financing, including parity legislation and managed care, may impact access for children with depression and manic depression (DMD).

Area of Science:

  • Child and Adolescent Psychiatry
  • Health Services Research
  • Mental Health Policy

Background:

  • An estimated 6.2% of US children meet criteria for depression, with about half not receiving treatment.
  • Barriers to treatment access, particularly financial ones, require examination within service systems.
  • Changes in healthcare financing, including parity legislation, managed care, and public contracting, may influence service access.

Purpose of the Study:

  • To review major changes affecting access to mental health services for children.
  • To analyze the potential impact of these changes on children with depression and manic depression (DMD).
  • To describe the service use patterns of children with DMD using Medical Expenditure Panel Survey data.

Main Methods:

  • Review of legislative changes: parity legislation, managed care, and public contracting.
  • Analysis of Medical Expenditure Panel Survey data to characterize service use in children with DMD.
  • Comparison of service use and payment patterns for children with DMD versus other pediatric mental health diagnoses.

Main Results:

  • Children with DMD exhibit higher expenditures, inpatient use, and Medicaid payment rates compared to other children with mental health diagnoses.
  • This population is disproportionately represented among the most costly pediatric mental illness cases.
  • Children with DMD have low out-of-pocket expenses, indicating limited impact of parity efforts focused solely on copayments and deductibles.

Conclusions:

  • Parity legislation focusing on copayments and deductibles may not significantly alleviate the financial burden for children with DMD.
  • Due to their high utilization of services, children with DMD are at increased risk from healthcare rationing mechanisms like utilization review and capitation.
  • Further research is needed to understand and mitigate potential negative impacts of healthcare system changes on this vulnerable population.

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