Estimating Mental Health Expenditures Using National Household Survey Data

描述（由申请人提供）：医疗支出小组调查（MEPS）是评估2010年患者保护和平价医疗法案对精神卫生保健支出影响的重要国家资源。然而，一般来说，已知MEPS未充分代表精神卫生支出，并且有证据表明，对于精神卫生保健支出高的人，偏见的程度可能更大。这项研究解决了长期存在的关于精神疾病患者MEPS支出估计准确性的问题。它还将为其他难以接触到的人群，如低收入艾滋病毒感染者和物质使用障碍患者，提供有关MEPS支出数据偏差的信息。该研究的具体目的是：1)量化按健康状况类别、保险覆盖范围和年龄定义的亚组，MEPS估计急诊就诊和住院护理年度支出的偏差；2)展示一种估算方法，该方法将为急诊患者和住院患者的亚群体实现更具代表性的医疗保健支出分布，这些亚群体在MEPS中代表性不足。国家住院病人数据库（SID）和国家急诊科数据库（SEDD）包含社区医院所有住院病人和急诊科就诊情况的完整普查。来自SID和SEDD的数据以及来自MEPS的数据将用于构建年度横截面样本，这些样本包括在日历年中至少有一次合格的急诊就诊或住院患者。然后，将对急诊部门和住院医院服务使用的支出以及MEPS支出的估计与SID/SEDD制定的这些相同数量进行比较。我们将使用从SID/SEDD中发展出来的时刻条件约束来检查支出差异，特别是与精神障碍诊断、物质使用障碍诊断、艾滋病毒、丙型肝炎、保险覆盖率和年龄组相关的支出差异。该研究的结果将为在家庭调查中可能难以达到的亚人群中MEPS支出偏差的重要性提供见解，并将为PPACA如何影响精神疾病患者的健康支出的未来研究提供初步证据。

DESCRIPTION (provided by applicant): The Medical Expenditure Panel Survey (MEPS) is a vital national resource for assessing the impacts of the 2010 Patient Protection and Affordable Care Act on mental health care expenditures. However, the MEPS is known to under-represent mental health expenditures, in general, and evidence suggests the magnitude of bias could be larger for persons with high expenditures for mental health care. This study addresses long- standing questions surrounding the accuracy of MEPS expenditure estimates for persons with mental illness. It also will provide information about biases in MEPS expenditure data for other hard-to-reach populations, such as low-income persons with HIV and persons with substance use disorders. The study's specific aims are: 1) to quantify, for subgroups defined by health condition category, insurance coverage, and age, the bias in MEPS estimates of annual expenditures for emergency department visits and inpatient care; and 2) to demonstrate an estimation method that will achieve a more representative health care expenditure distribution for subgroups of emergency department patients and inpatients that are underrepresented in MEPS. The State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) contain a complete census of all inpatient stays and emergency department visits at community hospitals. Data from the SID and SEDD and data from the MEPS will be used to construct annual cross-sectional samples of persons who had at least one qualifying emergency department visit or inpatient admission during a calendar year. MEPS estimates of expenditures for emergency department and inpatient hospital services use and expenditures in the MEPS will then be compared to these same quantities developed from the SID/SEDD. We will examine expenditure differences especially in relation to mental disorder diagnoses, substance use disorder diagnoses, HIV, Hepatitis C, insurance coverage, and age group, using moment condition constraints developed from SID/SEDD. The study's results will provide insight into the importance of MEPS expenditure biases for subpopulations that may be hard-to-reach in a household survey, and will provide preliminary evidence for a future study of how the PPACA impacts health expenditures for persons with mental illness. PUBLIC HEALTH RELEVANCE: National household survey data on expenditures for health care services are a vital national resource for policy analyses and for microsimulation studies of the impacts of national health care reforms. This study will provide new information about the accuracy of expenditures data in the Medical Expenditure Panel Survey, and will examine an innovative methodology for correcting biases in health expenditures data.