Citation

Marcus SC, Bridge JA, Olfson M. Am. J. Public Health 2012; 102(6): 1145-1153.

Affiliation

At the time of the study, Steven C. Marcus was with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the School of Social Policy and Practice of the University of Pennsylvania, Philadelphia. Jeffrey A. Bridge is with the Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, and the Department of Pediatrics, Ohio State University, Columbus. Mark Olfson was with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York, NY.

Copyright

(Copyright © 2012, American Public Health Association)

DOI

10.2105/AJPH.2011.300598

PMID

22515853

Abstract

Objectives. We investigated whether health insurance type (private vs Medicaid) influences the delivery of acute mental health care to patients with deliberate self-harm. Methods. Using National Medicaid Analytic Extract Files (2006) and MarketScan Research Databases (2005-2007), we analyzed claims focusing on emergency episodes of deliberate self-harm of Medicaid- (n = 8228) and privately (n = 2352) insured adults. We analyzed emergency department mental health assessments and outpatient mental health visits in the 30 days following the emergency visit for discharged patients. Results. Medicaid-insured patients were more likely to be discharged (62.7%), and among discharged patients they were less likely to receive a mental health assessment in the emergency department (47.8%) and more likely to receive follow-up outpatient mental health care (52.9%) than were privately insured patients (46.9%, 57.3%, and 41.2%, respectively). Conclusions. Acute emergency management of deliberate self-harm is less intensive for Medicaid- than for privately insured patients, although discharged Medicaid-insured patients are more likely to receive follow-up care. Programmatic reforms are needed to improve access to emergency mental health services, especially in hospitals that serve substantial numbers of Medicaid-insured patients. (Am J Public Health. Published online ahead of print April 19, 2012: e1-e9. doi:10.2105/AJPH.2011.300598).

Language: en