INSURANCE AND PROVIDER CHOICE FOR CHILDREN WITH MH NEEDS

描述(改编自申请者摘要)：拟议的研究 将模拟保险覆盖面变化对水平的影响 精神障碍儿童的服务使用情况，包括基于学校的服务 关于卫生需求以及这种用途在不同类型中的分布 心理健康提供者的名单。这项研究将检查来自NIMH的数据 1992年儿童与青少年流行病学方法学(MECA) 云南省4个地区1280名社区儿童青少年调查 美国。此数据集包括对 儿童的社会经济地位，他们对心理健康服务的使用， 感知到的服务使用障碍，以及多项心理测量 健康损害和诊断。 医改将影响精神健康保险覆盖面 通过为未参保的人提供保险，扩大儿童的心理健康覆盖范围 目前参保的大多数人，搬家的许多儿童目前都在参保 将医疗补助纳入私人医疗计划，并提供激励措施 用于选择管理型保健计划的家庭。保险方面的这些变化 覆盖范围可能会改变服务的使用水平和组合 有心理健康需求的儿童所使用的提供者。当人们的 保险覆盖率提高，他们可能会取代私人承保 现有公共资助提供商的服务提供商，或者他们可以 用新投保补充他们对公共资助提供者的使用 服务。保险覆盖面扩大的净影响 服务使用和国家精神卫生支出将取决于程度 在不同类型的儿童之间的提供者类型之间的这种替代 心理健康需求。在水平和水平上发生这种变化的可能性 服务使用类型是相当可观的：虽然这是一个普遍接受的估计 可诊断的精神病理学的患病率约为20%， 在MECA数据中，30%的受访者表示需要精神上的 过去一年内的医疗服务。 拟议的分析将使用服务使用的经济模型作为 模拟保险扩张对服务影响的框架 使用。在此模型中，使用特定提供程序类型(或在 所有)，被视为两个阶段决策过程的结果： 关于保险的决定和供应商的选择。这一过程的第一阶段 决策过程，即保险计划的选择，可以用以下方法进行研究 利用MECA数据集的丰富数据的简单统计模型 有关儿童心理健康损害和诊断的信息。 第二阶段的分析将利用各种统计数据 检查不同类型的提供者是否为替代品的模型 或者是补充。最后，分析将利用这四个因素 基于区域、普查区域的MECA抽样调查设计研究 保险扩张对非金融壁垒的可能影响 服务使用。

DESCRIPTION (adapted from Applicant's Abstract): The proposed research will simulate the effect of changes in insurance coverage on the level of service use, including school-based services, by children with mental health needs and on the distribution of this use among different types of mental health providers. The study will examine data from NIMH's 1992 Methodological Epidemiology of Children and Adolescents (MECA) study of 1280 community children and adolescents from 4 regions of the United States. This dataset includes detailed descriptions of the socioeconomic status of children, their use of mental health services, perceived barriers to service use, and multiple measures of mental health impairment and diagnosis. Health reform will affect the mental health insurance coverage of children by insuring the uninsured, expanding mental health coverage for most of the currently insured, moving many children currently covered by Medicaid into private health plans, and providing incentives to families to select managed-care type plans. These changes in insurance coverage are likely to alter both the level of service use and the mix of providers used by children with mental health needs. When people's insurance coverage improves, they may substitute privately-covered service providers for existing publicly-funded providers, or they may supplement their use of publicly-funded providers with newly insured services. The net effect of an expansion of insurance coverage on service use and national mental health spending will depend on the extent of such substitution between provider types among children with different mental health needs. The potential for such changes on the level and type of service use is considerable: while a generally accepted estimate of the prevalence of diagnosable psychopathology is approximately 20%, 30% of those surveyed in the MECA data expressed a need for mental health services within the last year. The proposed analysis will use an economic model of service use as a framework for simulating the effect of insurance expansion on service use.In this model, use of a particular provider type (or no provider at all), is viewed as the outcome of a two stage decision process: a decision about insurance and a provider choice. The first stage of this decision process, the choice of an insurance plan, can be studied using simple statistical models that exploit the MECA dataset's wealth of information about children's mental health impairments and diagnoses. The second stage of analysis will utilize a variety of statistical models to examine whether different types of providers are substitutes or complements. Finally, the analysis will capitalize on the four region, census tract based sampling design of the MECA study to examine the likely impact of insurance expansion on non-financial barriers to service use.