People with serious mental illnesses typically need to take medications regularly in order to feel and function well. They may have difficulty obtaining these medications and other health services if faced with high out-of-pocket costs. Reducing their use of medications could aggravate their illness, make daily living difficult, and result in relapse, need for hospitalization, or even suicide. Privately insured Americans, including many people living with bipolar disorder, are increasingly enrolled in a new type of health insurance—high-deductible health plans (HDHPs)—that require families to pay up to $12,900 of their medical expenses each year out-of-pocket before most coverage begins.
Given how common HDHPs are now, it is essential to understand how they affect healthcare use and health for patients with bipolar disorder. This study will use insurance claims from many thousands of anonymous patients with bipolar disorder to examine the impact of HDHPs on quality of care, adverse clinical outcomes, and patient out-of-pocket costs. Quality of care will be measured by, for example, regular use of medications and having regular mental health visits as recommended. Possible negative effects of HDHPs will include increased emergency department visits, hospitalizations, and longer hospital stays. Our project will compare HDHPs to traditional commercial insurance plans and also determine whether HDHPs that cover medications at lower costs to patients result in better outcomes than HDHPs that require higher costs. We will have a special focus on very vulnerable groups of bipolar patients, such as those with low incomes or those coping with more than one illness simultaneously. In addition, we will interview about 40 patients with bipolar illness to understand their experiences coping with complex insurance benefits, which types of care they value most, whether they sometimes skip medications or visits due to the costs, and how they make such decisions.
Our research will compare three types of insurance designs in order to make recommendations about how insurance can best protect patients with bipolar illness. Advocacy groups could use our findings to push for benefit offerings that meet patients’ needs; policy makers will be able to make decisions based on good evidence; and patients could use results to understand the consequences of their insurance choices.
A patient/stakeholder advisory panel and a major patient advocacy organization (the Depression and Bipolar Support Alliance [DBSA]) contributed to our proposal and will guide us through all phases of the study. DBSA helped develop a strong recruiting strategy for patient interviews and will use multiple outreach tools to provide us with regular feedback from patients in the community and share our results as they emerge.
Individuals with Multiple Chronic/co-morbid Conditions