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，MEPS是众所周知的精神卫生支出不足，一般来说，有证据表明，偏见的程度可能会更大的人与高支出的精神卫生保健。这项研究解决了长期存在的问题，围绕着MEPS支出估计的准确性，精神疾病患者。它还将提供有关MEPS支出数据中其他难以接触到的人群（如低收入艾滋病毒感染者和药物使用障碍者）的偏差的信息。该研究的具体目标是：1）量化，为健康状况类别，保险范围和年龄定义的亚组，MEPS估计的急诊科就诊和住院治疗的年度支出的偏差; 2）证明一种估计方法，将实现更有代表性的医疗保健支出分布的急诊科患者和住院患者的亚组在MEPS中代表性不足。州住院病人数据库（SID）和州急诊部数据库（SEDD）包含社区医院所有住院病人和急诊部就诊的完整普查。来自SID和SEDD的数据以及来自MEPS的数据将用于构建在一个日历年内至少有一次合格的急诊科就诊或住院患者的年度横断面样本。然后将MEPS中急诊科和住院医院服务使用的支出估计数和支出与SID/SEDD中开发的相同数量进行比较。我们将研究支出差异，特别是在精神障碍诊断，物质使用障碍诊断，艾滋病毒，丙型肝炎，保险范围，和年龄组，使用时刻条件约束开发SID/SEDD。这项研究的结果将提供深入了解MEPS支出偏差的重要性，可能是难以达到的亚群在家庭调查，并将提供初步证据，为未来的研究如何PPACA影响健康支出的人与精神疾病。 公共卫生相关性：关于保健服务支出的全国住户调查数据是政策分析和国家保健改革影响微观模拟研究的重要国家资源。这项研究将提供新的信息，支出数据的准确性，在医疗支出小组调查，并将审查一个创新的方法来纠正偏见的卫生支出数据。

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.