Modifications to Medicare policy that lowered out-of-pocket costs for outpatient mental health and substance use disorders (MHSUD) care to achieve parity with typical cost sharing under Medicare are interracial and interracial It was associated with uneven improvement in use of these services. Ethnic groups, studies suggested.
Specifically, MHSUD professional visits of white beneficiaries compared to a control group (2008) of beneficiaries who received free care throughout the study period were significantly more likely to be affected by the phasing in and implementation of a cost sharing reduction policy. increased during the period (2010-2013; 2014-2018). -2018; P.<0.001). But black, Hispanic, and Asian patients had smaller changes, reported Dr. Vicki Fung and colleagues at Massachusetts General Hospital and Harvard University in Boston.
In addition, reduced cost burden was also associated with an increased proportion of white beneficiaries filling prescriptions for MHSUD (P.<0.001).There was also an increase in black and Hispanic beneficiaries in the cost-sharing reduction group, but these changes "lagged significantly" behind changes in white beneficiaries, the authors note. health problems.
in response to Law passed in 2008Medicare introduced parity in cost sharing for outpatient MHSUD services with other health care services, gradually reducing the beneficiary’s out-of-pocket share of MHSUD spending from 50% in 2009 to 20% in 2014. .
“We hope that this policy will help increase access overall, and while use increased in all groups during the study period, there was less increase in beneficiaries of color than in white beneficiaries. ,” Fung said. Today’s Medpage.
Caucasian beneficiaries in the cost-sharing group also experienced a reduction in MHSUD emergency department visits and hospitalizations (P.=0.03). However, among Asian beneficiaries, reduced cost sharing was associated with a relative increase in such visits during the policy phase-in period compared to the pre-policy period (P.= 0.01).
The reasons for the increase are unclear, Fung said, citing literature suggesting that “Asians may wait until their mental symptoms worsen and are more likely not to seek treatment.” added.
Regarding spending, Fung and team found that for white beneficiaries, reduced cost sharing was associated with a relative increase in MHSUD medication spending and a relative decrease in MHSUD inpatient and total spending. I paid attention. For racial and ethnic minorities, changes in drug spending in his MHSUD related to reduced cost sharing were “smaller” than for white beneficiaries.
Previous studies have shown that poverty and out-of-pocket costs contribute to the gap between adequate use of MHSUD services and access to specialized care for racial and ethnic minorities, the authors said. says.
Equality efforts may have helped improve the affordability of MHSUD care, but racism and discrimination, language barriers, lack of culturally competent health care providers, health insurance knowledge and navigation Other ‘systemic barriers to treatment’, such as lack of investment in Support, Fung and colleagues explained.
“We don’t want to point out that these policies are unimportant or unhelpful, but if other structural and systemic barriers are not addressed, they will be disproportionately placed to care for communities of color. High barriers may still exist.
As for clinicians, Fung emphasized the importance of screening and the need to “be aware of all the barriers patients face when seeking this care.”
Survey details
Fung reasoned that parity policies could reduce disparities in care, so she and her team analyzed changes in MHSUD service use and spending from 2008 to 2018, looking at “events. Use your studies to plot the differences between the differences.” We compared a cost-sharing reduction cohort with a control group that received free care throughout the study period, while comparing each racial and ethnic group.
The study included 286,276 traditional Medicare beneficiaries (average age 77 years, 71% women) who earned between 100% and 135% of the federal poverty level and who received free care in 2008. , included 734,280 beneficiaries whose income was less than that. 100% of federal poverty level (mean age 77 years, 70% female).
Most of the beneficiaries were white. Of the cost share reduction group, 15% were Black, 9% Hispanic, and 2% Asian, and the free care group was 16% Black, 20% Hispanic, and 15% Asian.
One of the limitations of this study is that the sample did not include a sufficient number of Native American/Alaska Native beneficiaries to detect meaningful differences.
Fung also said that she and her colleagues were unable to assess certain variables, such as “those who really needed mental health treatment, or those who sought mental health treatment but were unable to receive it.”
Additionally, the study focused on low-income beneficiaries, so the results may not be generalizable to high-income beneficiaries.
Disclosure
This work was supported by grants from the National Institute for Minority Health and Health Disparities, the Agency for Medical Research and Quality, the Centers for Medicare and Medicaid Services, the Minority Health Administration, and the Health Equity Data Access Program.
Fung did not report disclosures. Co-authors reported multiple relationships with industry.
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Source reference: Fung V, et al. Equal coverage and racial and ethnic disparities in mental health and substance use care among Medicare beneficiaries. Health Affairs 2023; DOI: 10.1377/hlthaff.2022.00624.
