Health Care Spending, Use, and Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With Mental Health Symptoms

Sungchul Park; David J Meyers; Daniel Enrique Jimenez; Nattalie Gualdrón; Benjamin Le Cook

doi:10.1016/j.jagp.2024.01.014

Health Care Spending, Use, and Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With Mental Health Symptoms

Am J Geriatr Psychiatry. 2024 Jan 17:S1064-7481(24)00014-9. doi: 10.1016/j.jagp.2024.01.014. Online ahead of print.

Authors

Sungchul Park¹, David J Meyers², Daniel Enrique Jimenez³, Nattalie Gualdrón⁴, Benjamin Le Cook⁵

Affiliations

¹ Department of Health Policy and Management (SP), College of Health Science, Korea University, Seoul, Republic of Korea; BK21 FOUR R&E Center for Learning Health Systems (SP), Korea University, Seoul, Republic of Korea. Electronic address: sungchul_park@korea.ac.kr.
² Department of Health Services, Policy, and Practice (DJM), School of Public Health, Brown University, Providence, RI, USA.
³ Department of Psychiatry and Behavioral Sciences (DEJ), Miller School of Medicine, University of Miami, Coral Gables, FL, USA.
⁴ Health Equity Research Lab (NG, BLC), Cambridge Health Alliance, Cambridge, MA, USA; Department of Community Health (NG), School of Arts and Sciences, Tufts University, Medford, MA, USA.
⁵ Health Equity Research Lab (NG, BLC), Cambridge Health Alliance, Cambridge, MA, USA; Center for Health Equity (BLC), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Psychiatry (BLC), Harvard Medical School, Cambridge, MA, USA.

PMID: 38267358
DOI: 10.1016/j.jagp.2024.01.014

Abstract

Objective: We examined the differences in health care spending and utilization, and financial hardship between Traditional Medicare (TM) and Medicare Advantage (MA) enrollees with mental health symptoms.

Design: Cross-sectional study.

Participants: We identified Medicare beneficiaries with mental health symptoms using the Patient Health Questionnaire-2 and the Kessler-6 Psychological Distress Scale in the 2015-2021 Medical Expenditure Panel Survey.

Measurements: Outcomes included health care spending and utilization (both general and mental health services), and financial hardship. The primary independent variable was MA enrollment.

Results: MA enrollees with mental health symptoms were 2.3 percentage points (95% CI: -3.4, -1.2; relative difference: 16.1%) less likely to have specialty mental health visits than TM enrollees with mental health symptoms. There were no significant differences in total health care spending, but annual out-of-pocket spending was $292 (95% CI: 152-432; 18.2%) higher among MA enrollees with mental health symptoms than TM enrollees with mental health symptoms. Additionally, MA enrollees with mental health symptoms were 5.0 (95% CI: 2.9-7.2; 22.3%) and 2.5 percentage points (95% CI: 0.8-4.2; 20.9%) more likely to have difficulty paying medical bills over time and to experience high financial burden than TM enrollees with mental health symptoms.

Conclusion: Our findings suggest that MA enrollees with mental health symptoms were more likely to experience limited access to mental health services and high financial hardship compared to TM enrollees with mental health symptoms. There is a need to develop policies aimed at improving access to mental health services while reducing financial burden for MA enrollees.

Keywords: Medicare Advantage; financial hardship; health care spending; mental health; mental health services utilization; traditional Medicare.