Full access
Articles
Published Online: 4 September 2019

Effects of ACA Expansion of Dependent Coverage on Hospital-Based Care of Young Adults With Early Psychosis

Susan H. Busch, Ph.D. [email protected], Ezra Golberstein, Ph.D., Howard H. Goldman, M.D., Ph.D., Christine Loveridge, M.P.Aff., Robert E. Drake, M.D., and Ellen Meara, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 70, Number 11
https://doi.org/10.1176/appi.ps.201800492
PDF/EPUBformats

Abstract

Objective:

Since 2010, the Affordable Care Act has required private health plans to extend dependent coverage to adults up to age 26. Because psychosis often begins in young adulthood, expanded private insurance benefits may affect early psychosis treatment. The authors examined changes in insurance coverage and hospital-based service use among young adults with psychosis before and after this change.

Methods:

The study included a national sample (2006–2013) of discharges and emergency department visits. Using a difference-in-differences study design, the authors compared changes in insurance coverage (measured as payer source), per capita admissions, and 30-day readmissions for psychosis before and after ACA dependent coverage expansion among targeted individuals (ages 20–25) and a comparison group (ages 27–29).

Results:

After dependent coverage expansion, hospitalization for psychosis among young adults was 5.8 percentage points more likely to be reimbursed by private insurance among the targeted age group (ages 20–25), compared with the slightly older age group (ages 27–29). Dependent coverage expansion was not associated with changes in overall insurance coverage, per capita admissions, or 30-day readmission for psychosis.

Conclusions:

Although dependent coverage expansion was unrelated to changes in use of hospital-based treatments for psychosis among young adults, care was more likely to be covered by private insurance, and coverage of these hospitalizations by public insurance decreased. This shift from public to private insurance may reduce public spending on young-adult treatments for early-episode psychosis but may leave young adults without coverage for rehabilitation services.

Formats available

You can view the full content in the following formats:

View PDF/ePubView Full Text

Supplementary Material

File (appi.ps.201800492.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 70 • Number 11 • November 01, 2019
Pages: 1027 - 1033
PubMed: 31480928

History

Received: 30 October 2018
Revision received: 3 April 2019
Revision received: 3 June 2019
Revision received: 17 June 2019
Accepted: 21 June 2019
Published online: 4 September 2019
Published in print: November 01, 2019

Keywords

  1. Schizophrenia
  2. Insurance
  3. Psychosis

Authors

Affiliations

Susan H. Busch, Ph.D. [email protected]
Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
View all articles by this author
Ezra Golberstein, Ph.D.
Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
View all articles by this author
Howard H. Goldman, M.D., Ph.D.
Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
View all articles by this author
Christine Loveridge, M.P.Aff.
Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
View all articles by this author
Robert E. Drake, M.D.
Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
View all articles by this author
Ellen Meara, Ph.D.
Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
View all articles by this author

Notes

Send correspondence to Dr. Busch ([email protected]).

Competing Interests

Dr. Meara reports receipt of research support from the Six Foundation Collaborative (Commonwealth Fund, John A. Hartford Foundation, SCAN Foundation, Robert Wood Johnson Foundation, Peterson Center on Healthcare, and the Milbank Memorial Fund). The other authors report no financial relationships with commercial interests.

Funding Information

National Institute of Mental Healthhttp://dx.doi.org/10.13039/100000025: R01MH106635
This work was supported by grant R01MH106635 from the National Institute of Mental Health (NIMH).

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard
Tips for downloading citations

There are no citations for this item

View Options

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Item saved, go to cart
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share

×

As described within the American Psychiatric Association (APA)'s Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.