Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance

Kalmin, Mariah M.; Cantor, Jonathan H.; Bravata, Dena M.; Ho, Pen-Che; Whaley, Christopher; McBain, Ryan K.

doi:10.1001/jamanetworkopen.2023.36979

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…These results are consistent with the estimates of a 10-fold increase in tele-mental health care for commercially insured US adults and a 30-fold increase for youths between 2019 and 2022. 13 , 14 Following relationship waiver implementation, evidence of increased utilization of tele-mental health care is restricted to out-of-state telehealth as a share of out-of-state mental health visits only. The insignificant association with tele-mental health care as a share of total mental health visits might result from increased utilization in the Chicago MSA, offset by decreased utilization in the Davenport and St. Louis MSAs.…”

Section: Discussionmentioning

confidence: 99%

Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019–2021

Koumpias,

Fleming,

Lin

2024

Health Affairs Scholar

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During the COVID-19 public health emergency, states waived in-state licensure and pre-existing patient-physician relationship requirements to increase access to care. We exploit this state telehealth policy variation to estimate the association of in-state licensure requirement waivers and pre-existing patient-physician relationship requirement waivers with out-of-state tele-mental healthcare utilization of patients diagnosed with COVID-19. Using claims from January 2019 till December 2021 of 2,037,977 commercially insured individuals in 3 metropolitan statistical areas (MSA) straddling Midwestern state borders, we find increased out-of-state telehealth utilization as a share of out-of-state mental healthcare by 0.1411 and 0.0575 visits per month or 1,679.76% and 467.48% after licensure and relationship waivers, respectively. Within-MSA analyses illustrate an urban-rural digital divide in out-of-state utilization as a share of total or telehealth mental healthcare. Our findings indicate waivers primarily enhance access to care of established patients by enabling the transition of in-person out-of-state healthcare online. Interstate medical licensure compact participation may provide broader access to out-of-state tele-mental healthcare than emergency waivers.

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Section: Discussionmentioning

confidence: 99%

Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019–2021

Koumpias,

Fleming,

Lin

2024

Health Affairs Scholar

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“…The prevalence of pediatric mental health (MH) conditions and the demand for behavioral health services is growing in the US. 1 , 2 , 3 However, the current contribution of pediatric MH conditions to overall household health care expenditures is unknown. This study assesses medical spending for children with a MH condition between 2017 and 2021.…”

Section: Introductionmentioning

confidence: 99%

Medical Spending Among US Households With Children With a Mental Health Condition Between 2017 and 2021

Loo,

Altman,

Bravata

et al. 2024

JAMA Netw Open

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“…Little is also known about changes in outpatient mental health care for children and adolescents during the pandemic. Analyses of insurance claims have yielded conflicting results, with reports of decreasing and increasing mental health encounters from the prepandemic (2019) to pandemic (2020-2021) periods. A key limitation of claims analyses is that they do not offer insights into the proportion of youth in need of mental health care who receive it.…”

Section: Introductionmentioning

confidence: 99%

Mental Health Impairment and Outpatient Mental Health Care of US Children and Adolescents

Olfson,

McClellan,

Zuvekas

et al. 2024

JAMA Psychiatry

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ImportanceDespite a federal declaration of a national child and adolescent mental health crisis in 2021, little is known about recent national trends in mental health impairment and outpatient mental health treatment of US children and adolescents.ObjectiveTo characterize trends in mental health impairment and outpatient mental health care among US children and adolescents from 2019 to 2021 across demographic groups and levels of impairment.Design, Setting, and ParticipantsSurvey study with a repeated cross-sectional analysis of mental health impairment and outpatient mental health care use among youth (ages 6-17 years) within the 2019 and 2021 Medical Expenditure Panel Surveys, nationally representative surveys of US households. Race and ethnicity were parent reported separately from 15 racial categories and 8 ethnic categories that were aggregated into Black, non-Hispanic; Hispanic; Other, non-Hispanic; and White, non-Hispanic.ExposureTime period from 2019 to 2021.Main Outcomes and MeasuresAge- and sex-adjusted differences between 2019 and 2021 in mental health impairment measured with the Columbia Impairment Scale (a score ≥16 indicates severe; 1-15, less severe; and 0, no impairment) and age-, sex-, and Columbia Impairment Scale strata–adjusted differences in the use of any outpatient mental health care in 2019 and 2021.ResultsThe analysis involved 8331 participants, including 4031 girls and 4300 boys; among them, 1248 were Black and 3385 were White. The overall mean (SE) age was 11.6 (3.4) years. The percentage of children and adolescents with severe mental health impairment was 9.7% in 2019 and 9.4% in 2021 (adjusted difference, −0.3%; 95% CI, −1.9% to 1.2%). Between 2019 and 2021, there was also no significant difference in the percentage of children and adolescents with less severe impairment and no impairment. The overall annual percentages of children with any outpatient mental health care showed little change: 11.9% in 2019 and 13.0% in 2021 (adjusted difference, 1.3%; 95% CI, −0.4% to 3.0%); however, this masked widening differences by race. Outpatient mental health care decreased for Black youth from 9.2% in 2019 to 4.0% in 2021 (adjusted difference, −4.3%; 95% CI, −7.3% to −1.4%) and increased for White youth from 15.1% to 18.4% (adjusted difference, 3.0%; 95% CI, 0.0% to 6.0%).Conclusions and RelevanceBetween 2019 and 2021, there was little change in the overall percentage of US children and adolescents with severe mental health impairment. During this period, however, there was a significant increase in the gap separating outpatient mental health care of Black and White youth.

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Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance

Abstract: This cross-sectional study examines telehealth, in-person, and overall pediatric mental health service utilization and spending rates from January 2019 through August 2022 among a US pediatric population with commercial insurance.

Cited by 7 publications

References 6 publications

Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019–2021

Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019–2021

Medical Spending Among US Households With Children With a Mental Health Condition Between 2017 and 2021

Mental Health Impairment and Outpatient Mental Health Care of US Children and Adolescents

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