More patients with serious psychological distress had insurance coverage following the Affordable Care Act, but that didn’t change whether they’d seen a healthcare professional recently, researchers reported.
In an analysis of data from the National Health Interview Survey (NHIS), the number of uninsured adults ages 18 to 64 fell from 28.1% in 2012 to 19.5% in first 9 months of 2015, Robin Cohen, PhD, and Emily Zammitti, MPH, of the National Center for Health Statistics, reported in a Data Brief.
But there was no change in the proportion of adults with serious psychological distress who had a usual place to go for medical care or who had talked to a healthcare provider in the past year, they reported. These figures hovered just under 80% and just under 90%, respectively.
The findings were worse for mental healthcare specifically — the proportion of distressed adults who had seen a mental health professional in the past year fell during that time, from about 42% to 34%.
“This may be due to a number of factors, such as an increasing trend in obtaining mental health care from primary care providers or an increasing shortage of mental health professionals,” Cohen and Zammitti wrote. “Exploring these hypotheses requires further analysis, using more detail than NHIS provides.”
In this study, serious psychological distress was measured on the Kessler 6 nonspecific distress scale, which asks about the frequency of six symptoms, including nervousness and hopelessness, in the past month. Patients meeting this definition were about 3%-4% of the weighted sample during the analysis period.
The fall in the rate of uninsured in this population corresponded with an increase in private insurance coverage during that time, from 30% to 38%. Rates of public coverage remained relatively constant, they reported.
Cost-related barriers to care appear not to be an explanation for the decline in mental healthcare provision. The researchers found that many measures associated with not receiving care or delaying services due to cost fell during this period for patients with serious psychological distress.
In the first 9 months of 2015, fewer patients said they had forgone mental healthcare because of cost in the past year, and they were more able to afford necessary medical care and prescription drugs at the end of the study period.
Despite these improvements, disparities remain, Cohen and Zammitti wrote.
Although the percentage of uninsured had fallen to 19.5% among this group, this was still half again greater than the 12% of patients without distress who remained uninsured.
And about a quarter of patients with distress still reported being unable to pay for necessary medical care in the last year compared with only about 6% of those without the condition.
“It is possible that improved access does not necessarily lead to a successful treatment for serious psychological distress,” they wrote. “It is also possible that those who still have distress are increasingly those with poor access.”
The researchers disclosed no financial relationships with industry.