National Estimates of Health Insurance Coverage, Mental Health Utilization, and Spending for Low-Income Individuals
This report contains estimates of mental health treatment expenditures and selected population characteristics by health insurance status among low income individuals in the community population from the Medical Expenditure Panel Survey (MEPS).
Select for print version of National Estimates of Health Insurance Coverage ( PDF file, 370 KB).
This report contains estimates of mental health treatment expenditures and selected population characteristics by health insurance status among low income individuals in the community population from the Medical Expenditure Panel Survey (MEPS). Separate estimates are provided for adults aged 18-64 whose family incomes fall below 100 percent of the federal poverty line (FPL) in Table 1, 150 percent of the FPL in Table 2, and 200 percent of the FPL in Table 3. Similar tables for children aged 5-17 are provided in Table 4, Table 5, and Table 6. There were no statistically significant differences in average spending by urban/rural status for adults, consequently separate breakouts by urban/rural status are not provided. Table 7 provides breakdowns of mental health spending and utilization by urban/rural status for children aged 5-17. The two key things to note are:
- Reports of mental health symptoms and problems were strongly associated with mental health treatment use and spending.
- Low-income uninsured children and adults (18-64) were substantially less likely to have reported mental health symptoms and problems than low-income children and adults with Medicaid or Medicare coverage.
The Appendix Tables provide standard errors for these estimates. The data and methods are briefly described below.
Data and Methods
The data were drawn from the 2004-2006 Medical Expenditure Panel Survey. It was necessary to pool three calendar years of MEPS data (2004, 2005, and 2006) in order to support the subgroup analyses. The CMS Office of the Actuary's Personal Health Care Price Index was used to place expenditure amounts in constant 2006 dollars. All estimates presented here, thus, represent averages for the years 2004-2006 in constant 2006 dollars for the U.S. Civilian noninstitutionalized population.
Mental Health Treatment Expenditures include all mental health related expenditures related to office-based visits, hospital outpatient department visits, emergency department visits, inpatient hospital stays, and prescription medications and were estimated using method described in Zuvekas (2005). These estimates include treatment provided by non-specialists. Both total expenditures from all payment sources and the percent paid by Medicaid/SCHIP are presented.
Health Insurance Status
The low income population was divided into 5 mutually exclusive categories that describe their health insurance coverage for the entire calendar year:
- Medicare (including dual eligibles because Medicare is responsible for the bulk of spending, especially after the Medicare Part D program went into effect).
- Private health insurance coverage.
- Medicaid/SCHIP coverage.
- Part year uninsured (includes individuals with both private and Medicaid coverage for part of the year).
- Full year uninsured.
Further breakouts within these categories were not possible due to insufficient cell sizes.
Family income relative to the Federal Poverty Line was determined by summing personal income within families defined by Health Insurance Eligibility Units (HIEUs) provided on the MEPS public use files. This is a more restrictive definition of family than used by the Census Bureau's Current Population Survey from which the main estimates of poverty in the United States are derived. However, HIEUs come closer to how eligibility for coverage is determined for private health insurance coverage as well as public programs such as Medicaid. A full simulation of Medicaid eligibility, including income disregards, is beyond the scope of these analyses.
Mental Health Status
The Kessler K6 Psychological Distress Scale was used to divide adults into those experiencing severe psychological distress (K6>=13) and those who do not (K6<13). The K6 marker for severe psychological distress has been shown to be a good screener for severe mental illness (Kessler et al. 2003). It is also used in SAMHSA's National Survey on Drug Use and Health (NSDUH) and NCHS's National Health Interview Survey (NHIS), which are also nationally representative household surveys. MEPS estimates of the number of adults with severe psychological distress are slightly higher on average than the NHIS. This is possibly due to mode effects because the K6 is administered in MEPS as part of a self-administered paper and pencil questionnaire, whereas the K6 is interviewer administered in the NHIS. NSDUH estimates of severe psychological distress are approximately double the MEPS estimates. The NSDUH uses a modified K6 instrument which asks about the month in which they experienced the most distress in the last year, as opposed to the standard K6 questionnaire which asks about symptoms of distress over the last 30 days. That is, the NSDUH includes persons who do not currently have severe psychological distress.
The Columbia Impairment Scale was used to distinguish children aged 5-17 with significant behavioral impairments. The tables also include the percentage of adults and children for whom their perceived mental health status was rated by the MEPS household respondent as fair or poor on a scale of excellent, very good, good, fair, or poor. Perceived mental health status has been shown to be a strong predictor of mental health treatment use independent of mental health symptoms (Zuvekas and Fleishman 2008).
Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Archives of General Psychiatry 2003;60(2):184-9
Zuvekas SH. Prescription drugs and the changing patterns of treatment for mental disorders, 1996-2001. Health Affairs 2005 Jan/Feb;24(1):195-205.
Zuvekas SH. Health insurance, health reform, and outpatient mental health treatment: who benefits? Inquiry 1999;36:127-46.
Zuvekas SH, Fleishman JA. Self-rated mental health and racial/ethnic disparities in mental health service use, Medical Care 2008;46(9):915-213.
- Appendix Table 1
- Appendix Table 2
- Appendix Table 3
- Appendix Table 4
- Appendix Table 5
- Appendix Table 6
- Appendix Table 7