Posted by Phillipa on December 24, 2008, at 14:45:20
Seems the new payments for medicaire are upping compliance with follow up care following discharges from hospitals. Thought might be of interest wonder what private insurance compliance is? Phillipa
Timely Outpatient Psychiatric Care Depends on Insurance Coverage
December 23, 2008 Following hospitalization for mental illness, individuals with Medicare insurance with equal copayments for mental and physical healthcare full-parity insurance are more likely to go for timely outpatient care, a study reports.Individuals with full-parity insurance plans were 10.9% more likely to go for psychiatric follow-up within 30 days of discharge, compared with individuals without this type of insurance coverage.
"Medicare enrollees will seek follow-up care after a psychiatric hospitalization more often if their out-of-pocket costs are brought down to the same level as copayments for primary care," lead author Amal N. Trivedi, MD, from Brown University, in Providence, Rhode Island, told Medscape Psychiatry.
"People who receive timely follow-up care are less likely to be readmitted to a hospital, and they have more effective transitions to community-based services and better mental-health outcomes," he said. "Having equivalent primary-care and mental-health copayments is particularly important for people living in areas with low income and education levels."
The study is published in the December 24/31 issue of the Journal of the American Medical Association.
History of High Copayments
Historically, insurers in the United States required higher copayments for mental-healthcare services and have placed more restrictions on these services than on medical healthcare services, the researchers write.
In July and October 2008, however, the US Congress passed bills requiring insurance parity for mental-health services in Medicare Part B and in group health plans covering more than 50 employees, beginning in 2010.
To assess how parity of insurance coverage of mental health and physical health is related to quality of mental healthcare, the researchers analyzed data from 43,892 enrollees in 173 Medicare managed-care health plans. The study subjects had been hospitalized for a mental illness at some time between 2002 and 2006.
The study outcomes were 2 Health Plan Employer Data and Information Set (HEDIS) quality indicators: visiting a mental-health practitioner within 7 days or within 30 days of being discharged from the hospital.
The study subjects were classed as belonging to 1 of 3 types of health insurance plans, depending on whether the copayment for mental health was:
Equal to or less than that for primary care (full parity, 21% of participants).
Equal to or less than that for specialty care (intermediate parity, 32%).
Greater than that for primary care or specialty care (no parity, 47%).
The mean copayment for a mental health visit was $20.36, compared with $10.04 for a visit to a primary-care practitioner and $18.06 for a visit to a specialist.Individuals in full-parity plans were 10.5% more likely to visit a mental-health practitioner within 7 days and 10.9% more likely to visit one within 30 days compared with individuals with no parity, after adjustment for multiple factors.
"Disturbingly Low" Follow-Up
"Higher copayments are a potent deterrent to receiving appropriate follow-up care after a psychiatric hospitalization," said Dr. Trivedi.
For example, the rate of 7-day follow-up in individuals with mental-health copayments of $15 or less was 37.5%, vs 29.6% among those with copayments of more than $30.
"Parity legislation that equalizes cost sharing for mental health and primary care may increase the use of clinically appropriate mental-health services," the researchers write.
Other factors may also play a role. "The overall rate of follow-up after a psychiatric hospitalization was disturbingly low, even for plans with full parity, suggesting that parity alone is insufficient to raise the quality of mental healthcare to acceptable levels," the researchers write.
Other factors that affect mental healthcare include getting a referral to a mental-health practitioner and ability to get an appointment with such a practitioner.
Dr. Trivedi reports no financial disclosures. The research was supported by a Health Policy Scholars Award from the Pfizer Foundation and a grant from the Agency for Healthcare Research and Quality.
JAMA. 2008;300:2879-2885.
poster:Phillipa
thread:870649
URL: http://www.dr-bob.org/babble/20081223/msgs/870649.html