Trends in Treatment and Spending for Patients Receiving Outpatient Treatment of Depression in the United States, 1998-2015
Trends in Treatment and Spending for Patients Receiving Outpatient Treatment of Depression in the United States, 1998-2015
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DOI：
10.1001/jamapsychiatry.2019.0633
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发表时间：
2019-08-01
期刊：
影响因子：
25.8
通讯作者：
Druss, Benjamin G.
中科院分区：
文献类型：
--
作者：
Hockenberry, Jason M.;Joski, Peter;Druss, Benjamin G.
这项对国家医疗支出小组调查数据的分析考察了 1998 年至 2015 年美国抑郁症门诊治疗的趋势。要点问题1998 年至 2007 年以及 2007 年至 2015 年美国人口抑郁症患病率和治疗支出的趋势如何变化？研究结果在对 1998 年、2007 年和 2015 年医疗支出小组调查的 86216 名个人进行的分析中，接受治疗的抑郁症患病率绝对增加，从 2007 年的每 100 人 2.88 人增加到 2015 年的每 100 人 3.47 人，而且这种治疗的比例越来越大，由保险承保，特别是医疗补助（从 19% 增加到36%）。含义这些趋势似乎与旨在增加抑郁症治疗保险覆盖范围的政策一致。背景在 1987 年至 1997 年显着增加之后，美国抑郁症治疗趋势从 1998 年至 2007 年略有增加。然而，自 2007 年以来扩大精神健康疾病保险覆盖范围的多项政策变化可能再次改变了这些趋势。目的研究 1998 年至 2015 年全国抑郁症门诊治疗趋势，特别关注2007 年至 2015 年。设计、背景和参与者这项对美国医疗服务使用情况和抑郁症治疗支出的分析评估了 1998 年 (n=22 953)、2007 年 (n=29 370) 和 2015 年 (n=33 893) 医疗支出小组调查 (MEPS) 的数据。参与者包括全国代表性调查的受访家庭。数据分析时间为2018年6月15日至12月18日。主要结果和措施抑郁症的门诊和药物治疗率；门诊就诊、心理治疗就诊和处方的计数；和支出。结果分析包括来自 1998 年、2007 年和 2015 年 MEPS 的 86216 名个人。受访者的平均 (SD) 年龄为 37.2 (22.7) 岁； 45086 名（52.3%）为女性，24312 名（28.2%）为西班牙裔，15463 名（17.9%）为黑人，62926 名（72.9%）为白人。抑郁症门诊治疗率从 1998 年的每 100 人 2.36 例（95% CI，2.12-2.61）增加到 2015 年的每 100 人 3.47 例（95% CI，3.16-3.79）。使用心理治疗治疗抑郁症的受访者比例从 53.7%（95% CI， 1998 年的 48.3%-59.1%）增加到 2007 年的 43.2%（95% CI，39.0%-47.4%），然后增加到 2015 年的 50.4%（95% CI，46.0%-54.9%），而接受药物治疗的比例稳定在 81.9%（95% CI，39.0%-54.9%）。 1998 年为 77.9%-85.9%），2007 年为 82.4%（95% CI，79.3%-85.4%），2015 年为 80.8%（95% CI，77.9%-83.7%）。使用 2015 年美元对通货膨胀进行调整后，这些人的处方支出从 848 美元（95% CI， 1998 年每年 713-984 美元）到 2015 年每年 603 美元（95% CI，484-722 美元），而平均处方数量从 1998 年的 7.64 份（95% CI，6.61-8.67）下降到 2015 年的 7.03 份（95% CI，6.51-7.56）。 国家支出抑郁症门诊治疗费用从 1997 年的 12 430 000 000 美元增加到 2007 年的 15 554 000 000 美元，然后又增加到 2015 年的 17 404 000 000 美元，这与全国抑郁症门诊支出增长放缓相一致。来自自费（未参保）个人的支出百分比从 1998 年的 32% 下降到 2007 年的 29%，然后又下降到 2015 年的 20%。这种下降很大程度上与医疗补助覆盖范围的扩大有关，因为覆盖的支出百分比在 1998 年为 19%，2007 年为 15%，2015 年为 36%。 结论和相关性近期政策抑郁症保险覆盖范围增加的变化可能与未投保负担的减少以及抑郁症门诊治疗患病率和总体支出的适度增加有关。治疗率低于预期表明接受抑郁症治疗的个人仍然存在巨大障碍。
This analysis of national Medical Expenditure Panel Survey data examines trends in outpatient treatment of depression in the United States from 1998 to 2015.Key PointsQuestionHow did the trends in the prevalence of depression and spending for treatment in the US population shift from 1998 to 2007 and from 2007 to 2015? FindingsIn this analysis of 86216 individuals from the 1998, 2007, and 2015 Medical Expenditure Panel Surveys, an absolute increase occurred in the prevalence of treated depression from 2.88 per 100 in 2007 to 3.47 per 100 in 2015, and an increasing proportion of this treatment was covered by insurance, particularly Medicaid (increase from 19% to 36%). MeaningThese trends appear to be consistent with policies that were intended to increase insurance coverage of depression treatment.ContextAfter marked increases from 1987 to 1997, trends in depression treatment in the United States increased modestly from 1998 to 2007. However, multiple policy changes that expanded insurance coverage for mental health conditions may have shifted these trends again since 2007. ObjectiveTo examine national trends in outpatient treatment of depression from 1998 to 2015, with particular focus on 2007 to 2015. Design, Setting, and ParticipantsThis analysis of the use of health services and spending for treatment of depression in the United States assessed data from the 1998 (n=22 953), 2007 (n=29 370), and 2015 (n=33 893) Medical Expenditure Panel Surveys (MEPSs). Participants included respondent households to the nationally representative survey. Data were analyzed from June 15 through December 18, 2018. Main Outcomes and MeasuresRates of outpatient and pharmaceutical treatment of depression; counts of outpatient visits, psychotherapy visits, and prescriptions; and expenditures. ResultsThe analysis included 86216 individuals from the 1998, 2007, and 2015 MEPSs. Respondents' mean (SD) age was 37.2 (22.7) years; 45086 (52.3%) were female, 24312 (28.2%) were Hispanic, 15463 (17.9%) were black, and 62926 (72.9%) were white. Rates of outpatient treatment of depression increased from 2.36 (95% CI, 2.12-2.61) per 100 population in 1998 to 3.47 (95% CI, 3.16-3.79) per 100 population in 2015. The proportion of respondents who were treated for depression using psychotherapy decreased from 53.7% (95% CI, 48.3%-59.1%) in 1998 to 43.2% (95% CI, 39.0%-47.4%) in 2007 and then increased to 50.4% (95% CI, 46.0%-54.9%) in 2015, whereas the proportion receiving pharmacotherapy remained steady at 81.9% (95% CI, 77.9%-85.9%) in 1998, 82.4% (95% CI, 79.3%-85.4%) in 2007, and 80.8% (95% CI, 77.9%-83.7%) in 2015. After adjusting for inflation using 2015 US dollars, prescription expenditures for these individuals decreased from $848 (95% CI, $713-$984) per year in 1998 to $603 (95% CI, $484-$722) per year in 2015, whereas the mean number of prescriptions decreased from 7.64 (95% CI, 6.61-8.67) in 1998 to 7.03 (95% CI, 6.51-7.56) in 2015. National expenditures for outpatient treatment of depression increased from $12 430 000 000 in 1997 to $15 554 000 000 in 2007 and then to $17 404 000 000 in 2015, consistent with a slowing growth in national outpatient expenditures for depression. The percentage of this spending that came from self-pay (uninsured) individuals decreased from 32% in 1998 to 29% in 2007 and then to 20% in 2015. This decrease was largely associated with increasing Medicaid coverage, because the percentage of this spending covered was 19% in 1998, 15% in 2007, and 36% in 2015. Conclusions and RelevanceRecent policy changes that increased insurance coverage for depression may be associated with reduced uninsured burden and with modest increases in the prevalence of and overall spending for outpatient treatment of depression. The lower-than-expected rate of treatment suggests that substantial barriers remain to individuals receiving treatment for their depression.