Background/Purpose: To assess perception of access to mental health services (MHS) and utilization of those services based on participant’s insurance type. We compared responses of participants with public insurance (Medicare and Medicaid) and private insurance receiving rheumatologic care at an urban academic medical center.

Methods: Patients with rheumatic diseases seen in clinic and in private practices at a tertiary care academic medical center underwent a standardized interview by a single interviewer. Patient reported utilization of medical care and mental health services, as well as perceptions of access to those services was assessed using a standardized questionnaire. Socio-demographic variables were collected. Health characteristics included rheumatological diagnosis, physical functional status and mental health, measured by the SF36. High scores, reported on a scale from 0 to 100, define a more favorable health state. Responses from patients with public health insurance were compared to those with private commercial insurance.

Results: Participants with private insurance were more likely to be white (p=.037), married (p=.001) and home owners (p <.001), whereas participants with public insurance where more likely to be disabled (p=.074) and diagnosed with RA (p=.022) or SLE (p=.022). Those with private insurance scored higher on the SF-36 and were less likely to recognize role limitations due to emotional problems (p=.028), score lower for pain (p=.019) and to report worse physical function (p=.006). [Table 1]

Conclusion:

Of the 52 participants only 34 had received MHS in the past, 13/34 (38%) of public insurance patients, and 21/34 (61%) of private patients. Patients with public insurance were less likely to perceive barriers to access to mental health services than were those with private insurance, although that difference did not reach statistical significance (59% vs 24%, p= 0.227). In terms of relative ease of access to MHS vs physical health specifically, 38% of participants with public insurance felt they had less access to MHS than to medical services in general where as 61% of private practice patients reported perceiving less access to MHS (p=.041) than to medical services in general. The majority of participants in both private (76%) and clinic settings (76%) felt access to MHS was important to their well-being. Conclusion: Patients with rheumatic diseases commonly value the importance of mental health services, but frequently perceive barriers to access those services. Perhaps surprisingly, patients with public insurance were less likely to perceive such barriers than those privately insured. Future investigations should focus on identifying those specific barriers to mental health access for private and publicly insured patients in order to facilitate provision of such services.

Table 1. SF-36 component scores by insurance type

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/perception-of-access-to-mental-health-services-in-publicly-insured-vs-privately-insured-patients-with-rheumatic-diseases/