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Brief Report
Published Online: 11 September 2024

High Out-of-Pocket Cost Burden of Mental Health Care for Adult Outpatients in the United States

Y. Nina Gao, M.D., Ph.D. [email protected], and Mark Olfson, M.D., M.P.H.Authors Info & Affiliations
Publication: Psychiatric Services
In Advance
https://doi.org/10.1176/appi.ps.20240136
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Abstract

Objective:

This report describes characteristics of patients who had high out-of-pocket (OOP) spending on mental health care relative to income.

Methods:

A sample of 8,923 U.S. adults with outpatient mental health visits was drawn from the 2018–2021 Medical Expenditure Panel Survey. Respondents who spent ≥10% of their disposable family incomes on OOP mental health visits were defined as having a high OOP cost burden.

Results:

Using weighted percentages, the authors found that 2.4% of psychiatric outpatients had a high OOP burden; among those below the federal poverty level, 12.8% had a high OOP burden. Patients with a high (vs. low) OOP burden were statistically significantly more likely to be uninsured (7.5% vs. 2.4%) or diagnosed as having a substance use disorder (8.7% vs. 2.8%) or bipolar disorder (14.5% vs. 8.0%).

Conclusions:

Despite federal policies extending the availability of insurance for mental health care, many low-income psychiatric outpatients experience high OOP cost burden.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
In Advance

History

Received: 20 March 2024
Revision received: 20 May 2024
Accepted: 28 June 2024
Published online: 11 September 2024

Keywords

  1. insurance
  2. low income
  3. mental health care
  4. outpatient treatment
  5. poverty level

Authors

Details

Y. Nina Gao, M.D., Ph.D. [email protected]
Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (all authors); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson).
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Mark Olfson, M.D., M.P.H.
Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (all authors); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson).
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Notes

Send correspondence to Dr. Gao ([email protected]). Philip Wang, M.D., Dr.P.H., served as decision editor on the manuscript.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Dr. Gao was supported in part by a Moynihan Clinical Research Fellowship from the Leon Levy Foundation and by NIMH grant T32MH015144.No funding organization had any direct role in the design, development, interpretation, or approval of this study. The views expressed in this report are those of the authors and do not necessarily reflect the official views of NIH.

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