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》对精神卫生支出的影响的重要国家资源。然而，众所周知，欧洲议会议员总体上低估了精神卫生支出，有证据表明，对于精神卫生保健支出较高的人来说，偏见的幅度可能更大。这项研究解决了长期存在的问题，围绕着精神疾病患者的欧洲议会议员支出估计的准确性。它还将提供关于其他难以接触到的人群，如低收入艾滋病毒携带者和药物使用障碍者的欧洲议会支出数据中的偏见的信息。这项研究的具体目标是：1)对于由健康状况类别、保险覆盖范围和年龄定义的子组，量化MEP对急诊科就诊和住院治疗的年度支出估计的偏差；以及2)展示一种估计方法，以实现更具代表性的急诊科患者和住院患者子组在MEP中代表性不足的医疗支出分布。州住院病人数据库(SID)和州急诊部数据库(SEDD)包含对社区医院所有住院病人和急诊科就诊情况的全面普查。来自SID和SEDD的数据以及来自MEP的数据将被用来构建在一个日历年度内至少有一次合格的急诊科就诊或住院的人的年度横断面样本。MEP对急诊科和住院服务使用支出的估计以及MEP中的支出将与根据SID/SEDD得出的相同数量进行比较。我们将使用从SID/SEDD发展而来的瞬间条件限制来检查支出差异，特别是与精神障碍诊断、药物使用障碍诊断、艾滋病毒、丙型肝炎、保险覆盖范围和年龄组有关的支出差异。这项研究的结果将深入了解欧洲议会议员支出偏向对家庭调查中可能难以触及的亚群的重要性，并将为未来关于PPACA如何影响精神疾病患者的医疗支出的研究提供初步证据。 公共卫生相关性：关于保健服务支出的全国家庭调查数据是政策分析和国家保健改革影响的微观模拟研究的重要国家资源。这项研究将提供有关医疗支出小组调查中支出数据准确性的新信息，并将审查一种纠正卫生支出数据偏差的创新方法。

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.