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Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder.

Publication ,  Journal Article
Madden, JM; Araujo-Lane, C; Foxworth, P; Lu, CY; Wharam, JF; Busch, AB; Soumerai, SB; Ross-Degnan, D
Published in: J Affect Disord
February 15, 2021

BACKGROUND: Cost-sharing disproportionately affects people with chronic illnesses needing more care. Our qualitative study examined lived experiences navigating insurance benefits and treatment for bipolar disorder, which requires ongoing access to behavioral specialists and psychotropic medications. METHODS: Forty semi-structured telephone interviews with individuals with bipolar disorder and employer-sponsored health insurance, or their family caregivers, explored health care needs, coverage details, out-of-pocket (OOP) costs, and perspectives on value. An iterative analytic approach identified salient themes. RESULTS: Most individuals in our sample faced an annual insurance deductible, from $350-$10,000. OOP costs for specialist visits ranged from $0-$450 and for monthly psychotropic medications from $0-$1650. Acute episodes and care for comorbidities, including medication side effects, added to cost burdens. Medication nonadherence due to OOP costs was rare; respondents frequently pointed to the necessity of medications: "whatever it takes to get those"; "it's a life or death situation." Respondents also prioritized visits to psychiatrist prescribers, though visits were maximally spaced because of cost. Psychotherapy was often deemed unaffordable and forgone, despite perceived need. Interviewees cited limited networks and high out-of-network costs as barriers to specialists. Cost-sharing sometimes led to debt, skimping on nonbehavioral care or other necessities, exacerbated or prolonged mood symptoms, and stress at home. LIMITATIONS: Volunteer respondents may not fully represent the target population. CONCLUSIONS: Many people with bipolar disorder in US employer-sponsored plans experience undertreatment, hardship, and adverse health consequences due to high cost-sharing. More nuanced insurance benefit designs should accommodate the needs of individuals with complex conditions.

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Published In

J Affect Disord

DOI

EISSN

1573-2517

Publication Date

February 15, 2021

Volume

281

Start / End Page

41 / 50

Location

Netherlands

Related Subject Headings

  • Psychiatry
  • Insurance, Health
  • Humans
  • Health Expenditures
  • Health Care Costs
  • Cost Sharing
  • Bipolar Disorder
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

APA
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ICMJE
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Madden, J. M., Araujo-Lane, C., Foxworth, P., Lu, C. Y., Wharam, J. F., Busch, A. B., … Ross-Degnan, D. (2021). Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder. J Affect Disord, 281, 41–50. https://doi.org/10.1016/j.jad.2020.10.033
Madden, Jeanne M., Carina Araujo-Lane, Phyllis Foxworth, Christine Y. Lu, J Frank Wharam, Alisa B. Busch, Stephen B. Soumerai, and Dennis Ross-Degnan. “Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder.J Affect Disord 281 (February 15, 2021): 41–50. https://doi.org/10.1016/j.jad.2020.10.033.
Madden JM, Araujo-Lane C, Foxworth P, Lu CY, Wharam JF, Busch AB, et al. Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder. J Affect Disord. 2021 Feb 15;281:41–50.
Madden, Jeanne M., et al. “Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder.J Affect Disord, vol. 281, Feb. 2021, pp. 41–50. Pubmed, doi:10.1016/j.jad.2020.10.033.
Madden JM, Araujo-Lane C, Foxworth P, Lu CY, Wharam JF, Busch AB, Soumerai SB, Ross-Degnan D. Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder. J Affect Disord. 2021 Feb 15;281:41–50.
Journal cover image

Published In

J Affect Disord

DOI

EISSN

1573-2517

Publication Date

February 15, 2021

Volume

281

Start / End Page

41 / 50

Location

Netherlands

Related Subject Headings

  • Psychiatry
  • Insurance, Health
  • Humans
  • Health Expenditures
  • Health Care Costs
  • Cost Sharing
  • Bipolar Disorder
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences