title: Payment source and emergency management of deliberate self-harm.
abstract: OBJECTIVE
  We investigated whether health insurance type (private vs Medicaid) influences the delivery of acute mental health care to patients with deliberate self-harm.
  
  
  METHODS
  Using National Medicaid Analytic Extract Files (2006) and MarketScan Research Databases (2005-2007), we analyzed claims focusing on emergency episodes of deliberate self-harm of Medicaid- (n=8,228) and privately (n=2,352) insured adults. We analyzed emergency department mental health assessments and outpatient mental health visits in the 30 days following the emergency visit for discharged patients.
  
  
  RESULTS
  Medicaid-insured patients were more likely to be discharged (62.7%), and among discharged patients they were less likely to receive a mental health assessment in the emergency department (47.8%) and more likely to receive follow-up outpatient mental health care (52.9%) than were privately insured patients (46.9%, 57.3%, and 41.2%, respectively).
  
  
  CONCLUSIONS
  Acute emergency management of deliberate self-harm is less intensive for Medicaid- than for privately insured patients, although discharged Medicaid-insured patients are more likely to receive follow-up care. Programmatic reforms are needed to improve access to emergency mental health services, especially in hospitals that serve substantial numbers of Medicaid-insured patients.
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, School of Social Policy and Practice of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bridge
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000191:economics / Q000628:therapy*; D014481:United States; D055815:Young Adult