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Recent insurance policy changes for depression tied to increased treatment

Recent policy changes enacted between 1998 and 2015 to expand insurance coverage for mental health services was associated with increased prevalence of depression treatment without increasing prices or total spending, according to a study published in JAMA Psychiatry.

“Since 2007, multiple national policies have been implemented that may have further changed the prevalence and treatment patterns of depression,” Jason M. Hockenberry, PhD, from the department of health policy and management, Emory University, and colleagues wrote.

Policies enacted between 2007 and 2015 include the Mental Health Parity and Addiction Equity Act (MHPAEA), the Patient Protection and Affordable Care Act (ACA) and the Medicare Improvements for Patients and Providers Act of 2008, according to Hockenberry and colleagues.

“These policies, by reducing the cost of depression care to the beneficiary, would be expected to increase the amount of care consumed through increasing the prevalence of care seeking as well as the quantity of care consumed among those already receiving care,” they wrote.

In an analysis of health services use and spending for treatment of depression in the U.S., researchers examined the national trends in outpatient depression treatment from 1998 to 2015 — with particular focus on 2007 to 2015 — using data from the 1998, 2007 and 2015 Medical Expenditure Panel Surveys (n = 86,216). They evaluated rates of outpatient and pharmaceutical treatment for depression as well as number of outpatient visits, psychotherapy visits and prescriptions and health care service expenditures.

 

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The majority of respondents were female (52.3%) and white (72.9%), according to the findings. From 1998 to 2015, the investigators found that the rates of outpatient treatment for depression increased from 2.36 (95% CI, 2.12-2.61) per 100 population to 3.47 (95% CI, 3.16-3.79) per 100.

Analysis indicated that the proportion of respondents who received psychotherapy dropped from 53.7% (95% CI, 48.3-59.1) in 1998 to 43.2% (95% CI, 39-47.4) in 2007, but rose to 50.4% (95% CI, 46-54.9) in 2015. In contrast, the proportion of respondents receiving pharmacotherapy remained stable from 1998 to 2015 (81.9% [95% CI, 77.9-85.9] in 1998, 82.4% [95% CI, 79.3-85.4] in 2007 and 80.8% [95% CI, 77.9-83.7] in 2015).

The results showed that prescription expenditures for respondents using outpatient depression care declined from $848 per year in 1998 to $603 per year in 2015 and the average number of prescriptions declined from 7.64 (95% CI, 6.61-8.67) in 1998 to 7.03 (95% CI, 6.51-7.56) in 2015.

However, the national expenditures for outpatient treatment of depression continued to increase from $12,430,000 in 1997 to $15,554,000 in 2007 to $17,404,000 in 2015, according to the data. The percentage of this spending that came from uninsured persons dropped between these years from 32% in 1998 to 29% in 2007 to 20% in 2015, and this reduction was mainly linked to increasing Medicaid coverage (19% in 1998, 15% in 2007 and 36% in 2015).

“These findings still need to be balanced against the fact that the lower than-expected rate of treatment suggests that substantial barriers remain to individuals receiving treatment for their depression,” Hockenberry and colleagues wrote. “These factors may prove to be more difficult to address from a policy perspective because clinical inertia, community stigma and other constraints are not as easily addressed as mandating parity in insurance coverage and level of generosity.” – by Savannah Demko

Disclosure: Hockenberry reported grants from the Commonwealth Fund. The authors report no other relevant financial disclosures.