title: Use of hospital-based services among young adults with behavioral health diagnoses before and after health insurance expansions.
abstract: OBJECTIVE
  Young adults have high levels of behavioral health needs but often lack health insurance. Recent health reforms have increased coverage, but it is unclear how use of hospital-based care changed after expanding insurance. OBJECTIVE To evaluate the association between health insurance coverage expansions and use of hospital-based care among young adults with behavioral health diagnoses.
  
  
  METHODS
  Quasi-experimental analyses of community hospital inpatient and emergency department use from 2003-2009 based on hospital discharge data, comparing differential changes in service use among young adults with behavioral health diagnoses in Massachusetts vs other states before and after Massachusetts' 2006 health reform. This population-based sample included inpatient admissions (n = 2,533,307, representing 12,821,746 weighted admissions across 7 years) nationwide and emergency department visits (n = 6,817,855 across 7 years) from Maryland and Massachusetts for 12- to 25-year-old patients.
  
  
  METHODS
  Inpatient admission rates per 1000 population for primary diagnosis of any behavioral health disorder by diagnosis; emergency department visit rates per 1000 population by behavioral health diagnosis; and insurance coverage for hospital discharges.
  
  
  RESULTS
  After 2006, uninsurance among 19- to 25-year-old individuals in Massachusetts decreased from 26% to 10% (16 percentage points; 95% CI, 13-20). Young adults experienced relative declines in inpatient admission rates of 2.0 per 1000 for primary diagnoses of any behavioral health disorder (95% CI, 0.95-3.2), 0.38 for depression (95% CI, 0.18-0.58), and 1.3 for substance use disorder (95% CI, 0.68-1.8). The increase in emergency department visits with any behavioral health diagnosis after 2006 was lower among young adults in Massachusetts compared with Maryland (16.5 per 1000; 95% CI, 11.4-21.6). Among young adults in Massachusetts, the percentage of behavioral health discharges that were uninsured decreased by 5.0 (95% CI, 3.0-7.2) percentage points in inpatient settings and 5.0 (95% CI, 1.7-7.8) percentage points in emergency departments relative to other states.
  
  
  CONCLUSIONS
  Expanded health insurance coverage for young adults was not associated with large increases in hospital-based care for behavioral health, but it increased financial protection for young adults with behavioral health diagnoses and for the hospitals that care for them.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire2National Bureau of Economic Research, Cambridge, Massachusetts.
authors.forename: Ellen
authors.initials: E
authors.lastname: Meara
authors.affiliation: Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
authors.forename: Ezra
authors.initials: E
authors.lastname: Golberstein
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zaha
authors.affiliation: McLean Hospital, Belmont, Massachusetts6Harvard Medical School, Boston, Massachusetts.
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
authors.affiliation: Harvard Medical School, Boston, Massachusetts7Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: William R
authors.initials: WR
authors.lastname: Beardslee
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
mesh_terms: D000293:Adolescent; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland; D008404:Massachusetts; D017057:Medically Uninsured / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014600:Utilization Review; D055815:Young Adult