Utilization of Behavioral Health Services among Medicaid-Eligible Women with Pre-Existing Psychiatric Disorders during the Perinatal Period

Carol S. Larach

doi:10.17918/etd-6821

Objective: Using Behavioral Model of Health Services Use (Andersen, 1995) as a theoretical framework, this study (a) examined the patterns behavioral health service utilization among Medicaid-eligible women with pre-existing psychiatric disorders and established behavioral health treatment, and (b) investigated the individual-level factors associated with behavioral health services pre-pregnancy, during pregnancy, and the postpartum period. Methods: Administrative data from Community Behavioral Health were used in a retrospective cohort study design. The study included 813 women who (a) delivered babies (live births) between January 1, 2008 and December 31, 2008, (b) were residents of Philadelphia County, (c) were Medicaid-eligible during some or all of the study period, between January 1, 2006 to December 31, 2009, (d) had a primary DSM-IV-TR diagnosis of attention-deficit/disruptive behavior disorder, substance-related disorder, schizophrenia/psychotic disorder, mood disorder, anxiety disorder, impulse control disorder, or adjustment disorder, and (e) had an established behavioral health treatment history prior to pregnancy. Generalized estimating equations (GEE) were used to examine associations between predisposing, enabling, and need factors and four types of behavioral health services: (a) outpatient use (use vs. non-use; (b) number of outpatient visits; (c) inpatient use; and (d) number of inpatient days. Results: During pregnancy, rates of outpatient use decreased to 46%, but increased to 71% during the postpartum period. Similarly, rates of inpatient us decreased during pregnancy to 10%, but increased to 18% postpartum. Approximately 24% of the women made 35 or more outpatient visits, and 17% had 10 or more inpatient days. Predisposing (White and Hispanic race/ethnicity and older age), enabling (SSI without Medicare and days of Medicaid enrollment), and evaluated need (a mental health diagnosis) factors were associated with outpatient use. Predisposing (White race) and enabling (SSI without Medicare and days of Medicaid enrollment) factors were associated with the number of outpatient visits. Predisposing (White race) and enabling (days of Medicaid enrollment) factors were associated with inpatient use. The enabling factor, days of Medicaid enrollment, was associated with the number of inpatient days. Conclusion: Health insurance coverage via Medicaid was positively associated with behavioral health service use and intensity of use, but was not robust enough to decrease racial and ethnic disparities in behavioral health service use, suggesting an unmet need for behavioral health services among racial and ethnic minority perinatal women. Policy implications of these findings are discussed.

Utilization of Behavioral Health Services among Medicaid-Eligible Women with Pre-Existing Psychiatric Disorders during the Perinatal Period

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Utilization of Behavioral Health Services among Medicaid-Eligible Women with Pre-Existing Psychiatric Disorders during the Perinatal Period

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