Changes in insurance coverage and extent of care during the two years after first hospitalization for a psychotic disorder

Objective: This study examined changes in insurance coverage during the 24 months after first admission for a psychotic disorder and the relationship of insurance type to the extent of care. Methods: The sample consisted of 4 43 persons who were enrolled in the Suffolk County (New York) Mental Health Project. Information about coverage-private insurance, Medicaid-Medicare, or no insurance-was obtained from hospital records and interviews. The insu rance status groups were compared to examine differences in the percentage of days they received inpatient, outpatient, and day hospital care. Results and Conclusions: The proportion of persons with no insurance decreased fro m baseline to 24 months, from 42 percent to 21 percent. The proportion of p ersons with private insurance remained similar, 42 and 37 percent. The prop ortion of those with Medicaid-Medicare increased from 15 percent to 42 perc ent. Of those with Medicaid-Medicare at baseline (67 persons), 88 percent h ad such coverage 24 months later. Of those with private insurance at baseli ne (188 persons), 73 percent had the same coverage 24 months later. Of thos e with no insurance at baseline (188 persons), 35 percent had no insurance at 24 months, 54 percent had Medicaid-Medicare, and 11 percent had private insurance. Over the 24 months, the Medicaid-Medicare group had the most day s of care, the private insurance group had the least inpatient care, and th ose with no insurance were least likely to receive outpatient care. There w as a linear relationship between receiving more outpatient care and spendin g less time in the hospital and the day hospital.