Access and Cost Barriers to Mental Health Care by Insurance Status

Summarized by Madison Garrett PharmD

Rowan K, McAlpine DD, Blewett LA. Access and cost barriers to mental health care, by insurance status, 1999-2010. Health Aff (Millwood). 2013;32(10):1723-1730. doi:10.1377/hlthaff.2013.0133

Throughout 1999 to 2010, the Division of Health Policy and Management at the University of Minnesota conducted a study to assess accessibility and cost barriers to mental health care by insurance status. This was done by collecting data from the Integrated Health Interview Series which is a survey administered to a nationally representative sample of noninstitutionalized civilians. This data was collected among working age adults (18-64 years old) from 1999-2010. This survey gathered information about the respondents' use of mental health care and cost barriers to care. This determined whether they had received care from a mental health professional in the past 12 months or if they believed they needed mental health care but did not receive it due to cost. Respondents were divided according to mental health status (no mental illness, moderate mental illness, or serious mental illness) and insurance status (uninsured, publicly insured, or privately insured).

Insurance coverage among those with mental health problems:

  • According to the National Comorbidity Study, 47% of people stated they did not receive care due to cost or being uninsured

  • According to the Medical Expenditure Survey from 2004-2006, 37% of adults with severe mental illness were uninsured for part of the year

  • In 2007, those with serious psychological distress (SPD) were 40% less likely to be insured then those without SPD

  • In 2010, 33% of adults eligible for Medicaid met criteria for having a mental illness and 11% met criteria for having a serious mental illness

  • Rates of mental health care usage were found to be lowest in those who are uninsured and highest among those who are publicly insured

  • Throughout this study, individuals with mental illness were found more likely to be uninsured than individuals with no health issues

Mental illness vs insurance status

  • Mental illness was found to be significantly higher among publicly insured individuals and lowest among privately insured individuals

  • From 1999-2010, moderate mental illness increased among the publicly insured from 25.9% to 34.8% while it decreased among the privately insured from 50.2% to 39.8%

Access to mental health care

  • Out of the individuals included in this study, 20% with moderate mental illness accessed care while 44% with serious mental illness accessed care

  • Throughout this study, uninsured individuals had the least access to specialty care

  • Publicly insured individuals were found to have the most access to care: 49% with moderate mental illness received care and 69% with serious mental illness received care

Cost effect on mental health care

  • From 1999-2000, it was shown that the percentage of individuals who cited that cost prevented them from receiving care increased across all insurance groups

  • Uninsured individuals were the most likely to report cost as a barrier to receiving care

  • Individuals with serious mental illness that report cost as a barrier

    • Uninsured: 64%

    • Publicly insured: 18.2%

    • Privately insured: 30.3%

  • Throughout this study, it was found that the issue of cost increased as the severity of mental illness increased

Throughout this study, from 1999 to 2010, there was a decrease in employer sponsored health insurance and an increase in those with public health care coverage. Throughout this time, we also saw an increase in mental illness among working age adults: moderate mental illness increased from 3.7% to 5.1% and serious mental illness increased from 0.9% to 1.4%. Individuals with public insurance were found to have greater accessibility to mental health care than the privately insured.