Mental health care is a growing number of private insurance claims



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MWhole health care is a growing number of private insurance claims, according to a new report released Friday. But experts warned that more than anything else, the new data underscores how difficult it is to understand what is increasing the increasing use of mental health care.

The report found that claims related to depression, anxiety and a handful of other mental health issues were on the rise. There was a noticeable increase in the number of these youth demands, which represented a disproportionate share of mental health claims. Experts said the results may reflect increased access to treatment – but warned that it was difficult to determine the factors involved.

"It's very difficult to unravel [increased prevalence] increased recognition, more people with access to care and a willingness to fill out forms more honestly, "said Dr. Stephen Strakowski, a psychiatrist at the University of Texas at Austin School of Medicine. Strakowski, who runs the Center for Youth Mental Health at the school, was not involved in the report.

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The report is based on data from FAIR Health, a nonprofit health care organization with a database of more than 28 billion private health care claims records that, according to the report. organization, account for 75% of the private insurance market. The authors reviewed health insurance claims for behavioral care, which included both mental health and substance use treatment. They broke down the data into individual lines. A single health care visit may involve several lines of complaint, such as a chest x-ray and respiratory treatment.

Megan Thielking / STAT
Source: Spotlight on National Trends in Behavioral Health / FAIR Health

And while experts say the report is qualified, it offers a long-term picture of the use of mental health care by people with private insurance coverage in the United States.

"This allows us to pull a glass bottom boat into this ocean of claims and document the claims associated with [mental health care] trends, "said Robin Gelburd, president of FAIR Health.

The findings of the report among adolescents and young adults are particularly striking. Mental health claims have also increased among youth, which the report defines as 22 years old or younger. The report also found that young people represented a growing share of claims of major depressive disorder. In 2007, youth accounted for 15% of all claims related to severe depression. In 2017, they accounted for 23%.

Anxiety claims have also become more common among young people. Between 2007 and 2017, the number of claims for generalized anxiety disorders increased by 441% among young people aged 19 to 22. Anxiety-related demands have also increased significantly among adolescents and children.

Megan Thielking / STAT
Source: Spotlight on National Trends in Behavioral Health / FAIR Health

The report also found that claims lines with behavioral diagnoses increased by 108% over 2007 and 2017. In 2017, they accounted for 2.7% of all medical claim lines in the database. from FAIR Health. The most common diagnosis among mental health claims: major depressive disorder, which accounted for 26% of mental health reporting lines in 2017. The number of claim lines for generalized anxiety disorder also significantly increased during this period.

Megan Thielking / STAT
Source: Spotlight on National Trends in Behavioral Health / FAIR Health

The results have several important limitations, including the fact that they do not include people on public insurance or uninsured people. The report also does not detail the types of providers billed for services nor the frequency with which people accessed mental health care.

"Even if a person accesses an initial appointment, it does not mean that they receive adequate treatment. They could go to a therapeutic appointment or fill an anti-depressant prescription once, "said Dr. Ana Radovic, a teenage medicine specialist at the UPMC Children's Hospital in Pittsburgh, who does not have an antidepressant prescription. was not involved in the report.

According to experts, many factors are likely contributing to the increase in the number of youth mental health claims. There is an increased awareness of mental health issues and how to identify them. In 2009, the US Prevention Services Working Group recommended universal screening for depression in adolescents 12 years of age and older. At the same time, clinicians have reported that the stigma associated with seeking help for some mental health issues appears to be decreasing.

"We are paying more attention to recognizing the disease and improving children's access to mental health care," Strakowski said.

Policy changes could also be at stake, experts said. The Mental Health and Addiction Equity Act, passed by Congress in 2008, required many insurers to cover mental health and addiction treatment in the same manner as medical or surgical care. . And the Affordable Care Act allowed young people to continue to benefit from the insurance of their parents until the age of 26.

"What we're seeing right now is that people who need care are more likely to do so," Strakowski said. But he and other experts have noted that there are still serious barriers to access to mental health care for many people in the United States.

"There are still not many people getting the services they need," Radovic said.

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