Health Care Costs and Financing

Providing insurance coverage will not automatically ensure that mental health treatment needs are met

Mental health and substance abuse disorders currently affect about one-fourth of all adults between the ages of 18 and 64. However, previous studies have shown that less than one-third of those with a mental disorder can be expected to receive treatment for their condition over the course of a year. If universal insurance coverage were to be provided, it is projected that the number of currently uninsured people with major mental disorders using mental health treatment would rise by 40 percent. Despite this projected increase, less than 50 percent of those with a severe mental disorder would use mental health services, according to a simulation model of universal coverage policy. Thus, while insurance coverage can substantially increase the demand for treatment, simply extending insurance coverage would not be sufficient to meet the need for treatment, concludes a study by Samuel H. Zuvekas, Ph.D., of the Agency for Health Care Policy and Research.

Dr. Zuvekas used data from the National Institute of Mental Health's Epidemiologic Catchment Area (ECA) Study (1980-1985), which identified large segments of the general population at risk for needing mental health treatment, and data from AHCPR's 1987 National Medical Expenditure Survey (NMES) to develop simulation models that quantified changes in the use of outpatient mental health treatment among adults aged 18 to 64 years. He simulated two major types of reform proposals: universal coverage of all the uninsured and coverage of only the uninsured poor and near poor, which is typical of many expansions of State Medicaid programs.

Universal coverage simulations based on the ECA model suggest there would be a 62 percent increase in the percentage of the uninsured using mental health services. However, uninsured individuals with any lifetime disorder would have a smaller (54 percent) increase in the probability of a mental health visit compared with an 80 percent increase among the uninsured who had no disorder in their lifetime. Simulations based on the NMES model suggest that when only the uninsured with family incomes under 200 percent of poverty are provided public insurance, expenditures may be slightly better targeted toward those with poor mental health status. About 76 percent of additional visits would be made by those with poor mental health under the more limited policy, compared with 71 percent under the universal coverage policy.

See "Health insurance, health reform and outpatient mental health treatment: Who benefits?" by Dr. Zuvekas, in the Summer 1999 Inquiry 36, pp. 127-146. Reprints (AHCPR Publication No. 99-R078) are available from the AHCPR Clearinghouse.

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