Despite expansion of insurance coverage for depression, treatment rates are lower than expected

A new investigation published in JAMA Psychiatry finds that while insurance coverage for depression has increased, treatment rates are lower than expected, indicating that non-financial barriers to patient care still remain. Jason Hockenberry, PhD, associate professor at the Emory Rollins School of Public Health, is the lead author of the study.

"While insurance coverage has expanded, the growth in use of services has grown more modestly," says Hockenberry. "Taken in the context of other literature, this suggests there may be other barriers to treatment at work."

The researchers analyzed health services and spending data from the 1997, 2007 and 2015 Medical Expenditure Panel Surveys, which included the responses of 86,216 individuals. During the examined survey years, a number of new treatments and medications became available, as did an increase in policies targeted toward mental health (such as the expansion of Medicaid under the Affordable Care Act), which increased coverage of mental health services.

Findings from the researchers' analysis show an absolute increase in the prevalence of treated depression, and that the proportion covered by insurance (Medicaid in particular) has increased. Despite this, overall spending on depression-related care has only experienced a gradual increase (approximately 2 percent a year) from 1998 to 2015, and the rate of treatment for depression remains lower than the reported rate of incidence.

"Despite historic expansions of insurance coverage for individuals with mental health conditions, it appears that in this case the growth in use and cost has been more modest than some might have expected," says Hockenberry. "The main shift has been that Medicaid expenditures for this condition have increased markedly, with a concomitant decrease among those that do not have insurance."

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