The journal of mental health policy and economics
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J Ment Health Policy Econ · Dec 2008
Insurance coverage and the treatment of mental illness: effect on medication and provider use.
Canada's public health insurance system fully covers medically necessary hospital and physician services, but does not cover community-based non-physician mental health provider services or prescription drugs. Almost 2/3 of Canadians have private supplemental insurance for extended health benefits, typically through their employer, so its distribution is skewed to higher-income, employed Canadians, and typically features substantial cost-sharing and coverage limits. A recent national survey suggests only one-third of Canadians with selected mental disorders talked to a health professional during the previous 12 months and only a minority (19.3%) receive drug treatment. Financial barriers to care constitute a potentially important contributor to this under-use of mental health treatments. ⋯ Future research should incorporate insurance measures which capture details of coverage among all survey respondents. Linking survey to utilization data will help to overcome issues of recall bias.
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Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the antidepressant market. ⋯ Reducing differences in observable characteristics such as health insurance and education will mitigate racial and ethnic disparities in expenditures on antidepressant drug use and in the types of antidepressant used (e.g., generics vs. brands; new vs old). But these factors will have less influence in reducing racial and ethnic disparities in overall antidepressant drug utilization. To limit differences in overall antidepressant drug use, policymakers must take into account cultural factors and other sources of heterogeneity.