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The unmet needs in diagnosis and treatment of mood disorders in children and adolescents| Volume 49, ISSUE 12, P1128-1135, June 15, 2001

Service system finance: implications for children with depression and manic depression

  • Sherry Glied
    Correspondence
    Address reprint requests to Sherry Glied, Ph.D., Division of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th St., 6th Floor, New York, NY 10032
    Affiliations
    Division of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
    Search for articles by this author
  • Adam Neufeld
    Affiliations
    Division of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
    Search for articles by this author

      Abstract

      An estimated 6.2% of children in the United States satisfy the criteria for a depression diagnosis, but approximately half of this group do not receive necessary treatment. Thus it is important to consider potential barriers to use through service system finance.
      This article reviews three major types of changes affecting access: parity legislation, managed care, and public contracting. How these developments will affect children with depression and manic depression (DMD) is unclear.
      To better understand the potential effects on children with DMD, this review uses new data from the Medical Expenditure Panel Survey to describe the service use patterns of this population. These children have higher levels of expenditures, higher rates of inpatient use, and higher rates of Medicaid payment than do other children with mental health diagnoses; they also are overrepresented among the costliest cases of mental illness in children.
      Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copayments and deductibles will have little effect on the absolute out-of-pocket burden for these children. Because children with DMD are overrepresented among high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this population at particular risk.

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