Service use of rural and urban Medicaid beneficiaries suffering from depression: The role of supply

Despite the prevalence and consequence of depression in rural areas, the li terature on treating depression in rural areas is relatively scarce and inc onclusive. The use of mental health services by rural people suffering from depression and the role that supply may play in explaining these differenc es are not well understood Understanding these issues for rural Medicaid be neficiaries is important as Medicaid managed care for physical and behavior al health care is expanded to rural areas. This study compares the mental h ealth service use qi rural and urban Medicaid beneficiaries, ages 18 to 64, in Maine suffering from depression and examines what influence mental heal th and primary care supply have in explaining observed differences. Two mod els are used to estimate the use of ambulatory mental health services (1) a logit likelihood estimate of whether a beneficiary uses any outpatient men tal health services for depression; (2) an ordinary least squares regressio n estimating the number of annualized ambulatory mental health care visits among users. Rural beneficiaries suffering from depression have lower utili zation than urban beneficiaries. Rural and urban Aid for Families with Depe ndent Children (AFDC)- and Supplemental Security Income (SSI)-beneficiaries suffering from depression rely more on mental health than on general healt h care providers to receive ambulatory mental health care. Rural beneficiar ies (AFDC and SSI) rely relatively more on general health care providers th an urban beneficiaries. Multivariate analysis suggests that mental health s upply and patient-level factors, but naf primary care supply, account for u tilization differences. This article describes the need to better understan d factors limiting participation of primary care providers and to study the role of supply across multiple states.