ABSTRACT
Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance, though not the only cause. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits preexisting condition exclusions.
Subject(s)
Chronic Disease/economics , Insurance Coverage/statistics & numerical data , Insurance Selection Bias , Adult , Aged , Female , Health Insurance Portability and Accountability Act , Health Services Research , Humans , Indiana , Male , Medically Uninsured/statistics & numerical data , Middle Aged , Models, Statistical , Poverty , Sampling Studies , Surveys and Questionnaires , United StatesABSTRACT
This study identified differences in hospital utilization for mental health problems among depressed patients initially treated with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). A retrospective sample of 2,557 patients was obtained from a private insurance claims database. Quasi-experimental, two-stage multivariate regression modeling was used to estimate the likelihood of hospitalization and subsequent inpatient expenditures. Only 2% of the sample were hospitalized, and the average expenditures per admitted patient was about $8,000. Patients initially prescribed sertraline had the same likelihood of hospitalization for a mental health problem as patients prescribed TCAs. Patients initially prescribed fluoxetine were half as likely to be hospitalized as patients initially prescribed TCAs. Once hospitalized, no differential effects of a specific antidepressant on inpatient expenditures were found.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Depressive Disorder/drug therapy , Patient Admission/statistics & numerical data , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adolescent , Adult , Antidepressive Agents, Tricyclic/adverse effects , Antidepressive Agents, Tricyclic/economics , Cost-Benefit Analysis , Depressive Disorder/economics , Female , Humans , Male , Michigan , Middle Aged , Models, Econometric , Patient Admission/economics , Retrospective Studies , Selective Serotonin Reuptake Inhibitors/adverse effects , Selective Serotonin Reuptake Inhibitors/economics , Utilization ReviewABSTRACT
OBJECTIVES: Treatment of depression with medications and psychotherapy clearly is efficacious, but not all patients require such intensive therapy. In this report, we examine the costs and effects of dual treatment on a population of employees and their families with depression. We sought to determine the costs and length of medication treatment consequences of providing mental health specialty care to antidepressant-treated individuals. RESEARCH DESIGN AND SUBJECTS: A quasi-experimental retrospective design was used to examine the administrative data of 2678 antidepressant users whose insurance claims are included in the MarketScan database. The primary measure used was joint cost-continuity of antidepressant medication. RESULTS: Patients receiving concurrent psychotherapy were more likely to achieve length of antidepressant treatment consistent with current recommendations. The cost-consequence ratio for concurrent treatment was $4062/1% improvement in the number of adequately treated individuals. CONCLUSION: Adding psychotherapy to treatment with medication appears to improve the efficacy of antidepressant treatment. The incremental costs suggest that it is a valuable addition in most cases and should be considered cost-effective.
