Health Insurance Mental Illness

Health insurance churn among patients with schizophrenia

For any patients–but especially those with neurodevelopmental illnesses such as schizophrenia–have a consistent ‘medical home’ is vital for continuity of care. However, having consistent access to provider who know your medical history may be challenging if you frequently switch health insurance. “Insurance churn” is defined a patients who either transition between health plans or transition between having health insurance and being uninsured (or vice versa). A paper out last month at JMCP (Pesa et al. 2022) aims to examine whether the amount of insurance churn is higher for patients with schizophrenia. Using data from the Colorado All-Payer Claims Database and propensity score matching schizophrenia patients to non-schizophrenia patients, the authors find that:

The proportion of members with at least 1 churn event for the schizophrenia and nonschizophrenia cohorts, respectively, were 53.8% vs 36.5% after 12 months and 84.6% vs 69.2% after 48 months. Time to first churn event was significantly shorter in the schizophrenia cohort (16 months) than the nonschizophrenia cohort (23 months; P < 0.001). Schizophrenia cohort members had 64.1 and 56.8 churn events per 1,000 members per month vs 43.0 (P ≤ 0.001) and 42.8 (P = 0.011) churn events for nonschizophrenia cohort members in the first and second 6-month periods, respectively. Proportions of members in the schizophrenia and nonschizophrenia cohorts on public insurance, respectively, were 22.9% vs 6.9% after 12 months and 52.4% and 10.7% after 48 months. In the schizophrenia cohort, the most common churn event type was from commercial to public insurance rather than to a different commercial insurance…

Getting care for early-onset patients is particularly critical. As schizophrenia is a disease that gets worse over time unless treated, early treatment and disease management is vital. A paper by Golberstein et al. (2021) also examines health insurance churn but does so among first-episode psychosis patients using data from the RAISE-ETP (Recovery After an Initial Schizophrenia Episode–Early Treatment Program) study.

At baseline, levels of uninsurance (47%) and public insurance (31%) were higher among RAISE-ETP participants than among a similar age group in the general public (29% and 13%, respectively). Insurance transitions were common among people with FEP, although 79% of those with public insurance at baseline also had public insurance at 1 year. Of studied RAISE-ETP participants, 60% had a period of uninsurance during the year studied.

While there are certainly benefits of the U.S.’s decentralized system in terms of allowing for more innovation and different care models, lack of continuity of care is a key issue, especially for patients with serious conditions such as schizophrenia.

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