Skip to main content

Advertisement

SpringerLink
Log in

Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Older veterans can obtain care from the Veterans Affairs Health System (VA), Medicare or both. We examined whether their use of mental health care was impacted by capacity effects stemming from younger, uninsured veterans’ enrolling in VA to satisfy the individual mandate within Massachusetts Health Reform (MHR). Using administrative data, we applied a difference-in-difference approach to compare pre-post changes in mental health use following MHR implementation. Findings indicated MHR was associated with increases in use through Medicare and the probability of dual VA-Medicare use. These results provide support for the possibility that limited capacity led to care seeking outside VA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Angrist, J. D., & Pischke, J. S. (2008). Mostly harmless econometrics: An empiricist’s companion. Princeton: Princeton University Press.

    Book  Google Scholar 

  • Bertrand, M., Duflo, E., & Mullainathan, S. (2004). How much should we trust differences-in-differences estimates? Quarterly Journal of Economics, 119(1), 249–275.

    Article  Google Scholar 

  • Bond, A. M., & White, C. (2013). Massachusetts coverage expansion associated with reduction in primary care utilization among Medicare beneficiaries. Health Services Research, 48(6 Pt 1), 1826–1839.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buntin, M. B., & Zaslavsky, A. M. (2004). Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. Journal of Health Economics, 23(3), 525–542.

    Article  PubMed  Google Scholar 

  • Burgess, J. F. Jr., Maciejewski, M. L., Bryson, C. L., et al. (2011). Importance of health system context for evaluating utilization patterns across systems. Health Economics, 20(2), 239–251.

    Article  PubMed  Google Scholar 

  • Centers for Medicare and Medicaid Services. (2018). Berenson-Eggers type of service (BETOS) codes. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/downloads/BETOSDescCodes.pdf. Accessed 1 October 2018.

  • Department of Veterans Affairs. (2018). Veterans access, choice and accountability act of 2014 fact sheet. http://www.va.gov/opa/choiceact/documents/Choice-Act-Summary.pdf. Accessed 1 October 2018.

  • Department of Veterans Affairs. (2018). Department of Veterans Affairs FY 2018–2024 strategic plan. https://www.va.gov/oei/docs/VA2018-2024strategicPlan.pdf. Accessed 1 October 2018.

  • Department of Veterans Affairs. (2018). Corporate Data Warehouse (CDW). http://www.hsrd.research.va.gov/for_researchers/vinci/cdw.cfm. Accessed 1 October 2018.

  • Department of Veterans Affairs. (2018). VA Mental Health Services—Public Report. https://www.mentalhealth.va.gov/docs/Mental_Health_Transparency_Report_11-24-14.pdf. Accessed 1 October 2018.

  • Fortney, J. C., Burgess, J. F. Jr., Bosworth, H. B., Booth, B. M., & Kaboli, P. J. (2011). A re-conceptualization of access for 21st century healthcare. Journal of General Internal Medicine, 26(Suppl 2), 639–647.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gagne, J. J., Glynn, R. J., Avorn, J., Levin, R., & Schneeweiss, S. (2011). A combined comorbidity score predicted mortality in elderly patients better than existing scores. Journal of Clinical Epidemiology, 64(7), 749–759.

    Article  PubMed  PubMed Central  Google Scholar 

  • Huang, G., Kim, S., Gasper, J., et al. (2016). Survey of veteran enrollees’ health and use of health care. https://www.va.gov/HEALTHPOLICYPLANNING/SoE2016/2016_Survey_of_Veteran_Enrollees_Health_and_Health_Care.pdf. Accessed 1 October 2018.

  • Joynt, K. E., Chan, D. C., Zheng, J., Orav, E. J., & Jha, A. K. (2015). The impact of Massachusetts Health Care Reform on access, quality, and costs of care for the already-insured. Health Services Research, 50(2), 599–613.

    Article  PubMed  Google Scholar 

  • Long, S. K., & Masi, P. B. (2009). Access and affordability: An update on health reform in Massachusetts, fall 2008. Health Affairs, 28(4), w578–587.

    Article  PubMed  Google Scholar 

  • Long, S. K., Stockley, K., & Dahlen, H. (2012). Massachusetts health reforms: Uninsurance remains low, self-reported health status improves as state prepares to tackle costs. Health Affairs, 31(2), 444–451.

    Article  PubMed  Google Scholar 

  • McDonough, J. E., Rosman, B., Butt, M., Tucker, L., & Howe, L. K. (2008). Massachusetts health reform implementation: Major progress and future challenges. Health Affairs, 27(4), w285–297.

    Article  PubMed  Google Scholar 

  • Miller, S. (2012). The effect of the Massachusetts reform on health care utilization. Inquiry, 49(4), 317–326.

    Article  PubMed  Google Scholar 

  • Miller, S., & Wherry, L. R. (2017). Health and access to care during the first 2 years of the ACA medicaid expansions. The New England Journal of Medicine, 376(10), 947–956.

    Article  PubMed  Google Scholar 

  • Olenick, M., Flowers, M., & Diaz, V. J. (2015). US veterans and their unique issues: Enhancing health care professional awareness. Advances in Medical Education and Practice, 6, 635–639.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pande, A. H., Ross-Degnan, D., Zaslavsky, A. M., & Salomon, J. A. (2011). Effects of healthcare reforms on coverage, access, and disparities: Quasi-experimental analysis of evidence from Massachusetts. American Journal of Preventive Medicine, 41(1), 1–8.

    Article  PubMed  Google Scholar 

  • Patel, K., & McDonough, J. (2010). From Massachusetts to 1600 Pennsylvania avenue: Aboard the health reform express. Health Affairs, 29(6), 1106–1111.

    Article  PubMed  Google Scholar 

  • Pizer, S. D., & Prentice, J. C. (2011). Time is money: Outpatient waiting times and health insurance choices of elderly veterans in the United States. Journal of Health Economics, 30(4), 626–636.

    Article  PubMed  Google Scholar 

  • Research Data Assistance Center. (2018). Outpatient RIF. https://www.resdac.org/cms-data/files/op-rif. Accessed 1 October 2018.

  • Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167(5), 476–482.

    Article  PubMed  Google Scholar 

  • Sommers, B. D., Baicker, K., & Epstein, A. M. (2012). Mortality and access to care among adults after state Medicaid expansions. The New England Journal of Medicine, 367(11), 1025–1034.

    Article  PubMed  CAS  Google Scholar 

  • Sommers, B. D., Long, S. K., & Baicker, K. (2014). Changes in mortality after Massachusetts health care reform: A quasi-experimental study. Annals of Internal Medicine, 160(9), 585–593.

    Article  PubMed  Google Scholar 

  • Sullivan, G., Arlinghaus, K., Edlund, C., Kauth, M., & Kemp, J. (2018). Guide to VA mental health services for veterans and families. https://www.mentalhealth.va.gov/docs/guide_to_va_mental_health_srvcs_final12-20-10.pdf. Accessed 1 October 2018.

  • Tanielian, T., Farris, C., Batka, C., et al. (2014). Ready to serve: Community-based provider capacity to deliver culturally competent, quality mental health care to veterans and their families. Santa Monica: RAND Corporation.

    Google Scholar 

  • U.S. Department of Health and Human Services. (2018). Area health resource file. http://ahrf.hrsa.gov/index.htm. Accessed 1 October 2018.

  • U.S. Government Accountability Office. (2018). Number of veterans receiving care, barriers faced, and efforts to increase access. https://www.gao.gov/new.items/d1212.pdf. Accessed 1 October 2018.

  • Watkins, K. E., Smith, B., Akincigil, A., et al. (2016). The quality of medication treatment for mental disorders in the department of veterans affairs and in private-sector plans. Psychiatric Services, 67(4), 391–396.

    Article  PubMed  Google Scholar 

  • Wong, E. S., Maciejewski, M. L., Hebert, P. L., et al. (2018). Did massachusetts health reform affect veterans affairs primary care use? Medical Care Research and Review, 75(1), 33–45.

    Article  PubMed  Google Scholar 

  • Wong, E. S., Maciejewski, M. L., Hebert, P. L., Bryson, C. L., & Liu, C. F. (2014). Massachusetts health reform and Veterans Affairs health system enrollment. The American Journal of Managed Care, 20(8), 629–636.

    PubMed  Google Scholar 

Download references

Funding

Dr. Wong is supported by a VA Health Services Research and Development Career Development Award (CDA 13-024). Dr. Maciejewski (RCS 10-391) and Dr. Fortney (RCS 17-153) are VA Research Career Scientists.

Author information

Authors and Affiliations

  1. Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, HSR&D MS-152, Seattle, WA, 98108, USA

    Edwin S. Wong, Paul L. Hebert, John C. Fortney & Chuan-Fen Liu

  2. Department of Health Services, University of Washington, Seattle, WA, USA

    Edwin S. Wong, Paul L. Hebert & Chuan-Fen Liu

  3. Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA

    Matthew L. Maciejewski

  4. Department of Population Health Sciences, Duke University, Durham, NC, USA

    Matthew L. Maciejewski

  5. Department of Psychiatry, University of Washington, Seattle, WA, USA

    John C. Fortney

Authors
  1. Edwin S. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew L. Maciejewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul L. Hebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John C. Fortney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chuan-Fen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edwin S. Wong.

Ethics declarations

Conflict of interest

Dr. Wong reports ownership of common stock in UnitedHealth Group Inc. All other authors declare they have no potential conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Disclosures: The views expressed are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs, the University of Washington and Duke University.

Appendix

Appendix

See Tables 4 and 5.

Table 4 Summary of provider specialty codes and current procedural terminology codes for defining mental health visits
Full size table
Table 5 MHR difference-in-difference estimates by county-level uninsurance
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, E.S., Maciejewski, M.L., Hebert, P.L. et al. Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees. Adm Policy Ment Health 46, 145–153 (2019). https://doi.org/10.1007/s10488-018-0900-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-018-0900-z

Keywords

Search

Navigation