Service system finance: Implications for children with depression and manic depression

An estimated 6.2% of children in the United Stares satisfy the criteria for a depression diagnosis, but approximately half of this group do not receiv e necessary treatment. This it is important to consider potential barriers to use through sen,ice system finance. This article reviews three major typ es of changes affecting access: parity legislation, managed care, and publi c contacting. How these developments will affect children with depression a nd manic depression (DMD) is unclear To better understand the potential eff ects on children with DMD, this review uses new data from the Medical Expen diture Panel Survey to describe the service use patterns of this population . These children have higher levels of expenditures, higher rates of inpati ent use, and higher rates of Medicaid payment than do other children with m ental health diagnoses; they also are overrepresented among the costliest c ases of mental illness in children. Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copaym ents and deductibles will have little effect on the absolute out of-pocket burden for these children, Because children with DMD are over-represented a mong high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this po pulation at particular risk. (C) 2001 Society of Bioogical Psychiatry.