0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Use of Hospital-Based Services Among Young Adults With Behavioral Health Diagnoses Before and After Health Insurance Expansions

Ellen Meara, PhD1,2; Ezra Golberstein, PhD3; Rebecca Zaha, MPH4; Shelly F. Greenfield, MD, MPH5,6; William R. Beardslee, MD6,7; Susan H. Busch, PhD8
[+] Author Affiliations
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
2National Bureau of Economic Research, Cambridge, Massachusetts
3Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
4The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
5McLean Hospital, Belmont, Massachusetts
6Harvard Medical School, Boston, Massachusetts
7Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
8Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
JAMA Psychiatry. 2014;71(4):404-411. doi:10.1001/jamapsychiatry.2013.3972.
Text Size: A A A
Published online

Importance  Young adults have high levels of behavioral health needs but often lack health insurance. Recent health reforms have increased coverage, but it is unclear how use of hospital-based care changed after expanding insurance.

Objective  To evaluate the association between health insurance coverage expansions and use of hospital-based care among young adults with behavioral health diagnoses.

Design, Setting, and Participants  Quasi-experimental analyses of community hospital inpatient and emergency department use from 2003-2009 based on hospital discharge data, comparing differential changes in service use among young adults with behavioral health diagnoses in Massachusetts vs other states before and after Massachusetts’ 2006 health reform. This population-based sample included inpatient admissions (n = 2 533 307, representing 12 821 746 weighted admissions across 7 years) nationwide and emergency department visits (n = 6 817 855 across 7 years) from Maryland and Massachusetts for 12- to 25-year-old patients.

Main Outcomes and Measures  Inpatient admission rates per 1000 population for primary diagnosis of any behavioral health disorder by diagnosis; emergency department visit rates per 1000 population by behavioral health diagnosis; and insurance coverage for hospital discharges.

Results  After 2006, uninsurance among 19- to 25-year-old individuals in Massachusetts decreased from 26% to 10% (16 percentage points; 95% CI, 13-20). Young adults experienced relative declines in inpatient admission rates of 2.0 per 1000 for primary diagnoses of any behavioral health disorder (95% CI, 0.95-3.2), 0.38 for depression (95% CI, 0.18-0.58), and 1.3 for substance use disorder (95% CI, 0.68-1.8). The increase in emergency department visits with any behavioral health diagnosis after 2006 was lower among young adults in Massachusetts compared with Maryland (16.5 per 1000; 95% CI, 11.4-21.6). Among young adults in Massachusetts, the percentage of behavioral health discharges that were uninsured decreased by 5.0 (95% CI, 3.0-7.2) percentage points in inpatient settings and 5.0 (95% CI, 1.7-7.8) percentage points in emergency departments relative to other states.

Conclusions and Relevance  Expanded health insurance coverage for young adults was not associated with large increases in hospital-based care for behavioral health, but it increased financial protection for young adults with behavioral health diagnoses and for the hospitals that care for them.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Percentage of Population Uninsured

Patients uninsured if they said they had no Medicare, Medicaid, private coverage, or other source of coverage.19

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Change in Behavioral Health Admissions Per 1000 Before and After Health Reform

The graph shows the adjusted estimates and 95% CIs of the change in inpatient admissions per 1000 population for 19- to 25-year-old individuals in Massachusetts from 2003-2006 to 2007-2009, relative to the rest of the United States, netting out changes in admissions for 12- to 18-year-old individuals in Massachusetts and the rest of the United States.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Change in Emergency Department Visits With Behavioral Health Diagnoses Before and After Health Reform

The graph shows adjusted estimates and 95% CIs of the change in emergency department visits per 1000 population for 19- to 25-year-old individuals in Massachusetts from 2003-2006 to 2007-2009, relative to Maryland, netting out changes in emergency department visits for 12- to 18-year-old individuals in Massachusetts and Maryland. For visits for depression, substance use disorder (SUD), or psychosis, only indicates that no other behavioral health diagnosis was recorded for that visit. Other physical diagnoses may be present.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();