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Abstract: Mentally ill Medicaid recipients represent a population that may be vulnerable to limited access to adequate treatment for their mental illness. In this study, depressed Medicaid recipients were compared with those with private insurance. Also examined were racial differences among the Medicaid recipients in the treatment of depression. It was found that in comparison with Medicaid patients, the privately insured patients who are treated with antidepressants are more likely to receive the newer selective serotonin reuptake inhibitors (SSRIs) rather than the older tricyclic antidepressants (TCAs). In the Medicaid group, African Americans are more likely to receive TCAs than are white patients. Privately insured patients are more likely to receive psychotherapy than are Medicaid patients. There is a higher rate of continuous therapy on initial antidepressants in the privately insured group. Results suggest that depressed Medicaid recipients' access to quality mental health care is restricted. Also, among depressed Medicaid patients, there are racial differences with regard to depression treatment.
Key words: Depression, Medicaid, antidepressants, access to care, racial variation.
Depression is one of the most common illnesses seen in primary care and is associated with high rates of health service utilization when compared with other diseases seen in the general medical setting.lo It results in limitations in social functioning and high levels of disability,' so that the social costs associated with depression are higher than those related to either heart disease or arthritis.'
Unfortunately, recognition and access to adequate treatment remains a significant challenge.9 The National Comorbidity Survey (NCS) provides the most recent nationally representative estimates of the prevalence of mental illness in the United States." Among those respondents with three or more lifetime psychiatric disorders, only 60 percent ever receive any medical care for those illnesses, only one-third receive care for a current episode, and only one-fifth receive any specialty mental health care for the current episode.
Access to care for mental health services and depression has been compared to fee-for-service and managed care payment systems as part of the Rand Health Insurance Experiment and the Medical Outcomes Study.ll,l2 In general, there appears to be equal access to care under prepaid plans.l3 Cost savings may be achieved through cost sharing or prepayment, but individuals with the greatest psychological distress or the poor...