Prescription for Wellness

Access to Health Coverage

Health coverage is an important component in determining a person's quality of life and care. For the majority of persons diagnosed with a severe and persistent mental illness the high cost of mental and physical health care is often overwhelming and creates a barrier. Also, persons with private mental health insurance experience barriers in coverage. Medications are often limited in the health plan formulary, authorization for services is limited, and the array of services can also be limited. Those without private insurance most often rely on Medicare, Medicaid, and other federal, state, and local government resources. These resources are often difficult to access, limited in scope, and are subject to reductions or even the loss of the benefit. When these barriers occur, people with mental disorders are likely to use more expensive emergency services or no service at all. (USDHHS, 1999, p. 294).

The Robert Wood Johnson "Communities in Charge" Executive Committee of the Integrated Care Collaboration identified the following Central Texas crisis issues related to health care (Robert Wood Johnson, 2000): Health care for the medically indigent is currently provided by more than a dozen distinct organizations funded by federal, state, and local governmental dollars, as well as local philanthropic dollars, physician pro bono services, and modest client fees. The number of uninsured individuals in the Central Texas region is estimated to be 200,000. Approximately 1 in 100 residents are unemployed while 1 in every 5 has no health insurance.

• Complex enrollment processes make it difficult to access needed care.
• Uninsured persons who are below 100% of the federal poverty level often exceed the eligibility criteria for Medicaid.
• Fragmented funding systems contribute to duplication of services, lack of coordination, and lack of communication between service providers.
• Persons with depression lack sufficient supports to maintain optimal health.
• In 1997, 14,000 small businesses in Texas dropped their health care insurance plans.
• Planned reductions in annual Medicare expenditures may result in revenue loss for safety-net providers at an estimated $75-100 million in Hays, Travis and Williamson counties over the next five years.

In a recent article (Health Central, 2000) researchers predict that in the next 10-20 years Americans will be living longer. There will be a new generation of health plans utilizing new medical technologies to treat various diseases. Concerns continue to be expressed regarding the cost, quality and access to healthcare in the United States. These issues will continue to be a pressing issue in the years to come. Needless to say, persons with mental disorders will continue to have difficulty accessing appropriate health plans to meet their needs.

The report, titled "Health and Health Care 2010," (Health Central, 2000) includes the 10-year outlook according to experts at the Institute for the Future, a nonprofit organization based in Menlo Park, California, and the Princeton, New Jersey-based Robert Wood Johnson Foundation, the nation's largest healthcare philanthropy.

A few of the findings are:

• Many issues will dominate healthcare. Some of the primary issues will be determining how to improve Americans' health behaviors, how to involve consumers in the healthcare decision making process, and how to increase the number of Americans with health insurance.
• The current strong economy and job market has increased the security of health benefits for some people. There continues to be an issue of how to pay for care for a growing number of uninsured Americans. Future estimates range from 30 million to 65 million people without health insurance.
• Access to care will continue to be an issue. It is predicted that as time goes on there will be varying "tier" system. A top "tier", consisting of wealthier, better-educated consumers, will use technology to gain information about their health and engage in a decision making process with physicians. Next, consumers with little or no choice of health plans, and retirees with limited discretionary income. Last, a group consisting of the uninsured, people on Medicaid and others lacking access to market-based insurance.
• Most people with insurance will be enrolled in a HMO-like health plan. It will become increasingly difficult to distinguish one from another as plans will offer similar networks and rely on similar financing systems.
• Changing demographics will have an impact on healthcare. By 2010, it is expected that women will live to be an age of 86, on average, while men will live to be 76. The first baby boomers will be turning 65 in 2010. The population will be aging and there will be increased overall healthcare needs.
• By 2005, healthcare will account for about 15% of the gross domestic product. As in the past decade, business and government will deploy a host of strategies to curb healthcare spending. But those strategies, such as reducing insurance coverage and passing along the cost of healthcare premiums to consumers, will do more to "assuage the symptoms" than attack the root causes.
• Beyond 2005, the future landscape becomes less predictable. The report offers three different scenarios, ranging from a rosy vision of a "sustainable, efficient healthcare system" with broader health coverage to a pessimistic prediction for widespread malfunction, discontent and a population that includes 65 million people without health insurance (NIMH, 2000).

In a U.S. Senate Committee (May 2000), the General Accounting office reported there are employers who violate a 1996 law "barring insurance plans from imposing different annual or lifetime dollar limits for mental illness than for physical ailments, while many more plans are legally evading the requirement." In addition, Dr. Stephen Hyman, NIMH, informed the committee "there is no medical reason to limit coverage of mental health services." He further stated, "We have found no reason based on biomedical or behavioral science why mental disorders should be treated differently from any other medical disorder" (Hearing on Mental Health Insurance Parity).

Top Of Page
Description of Adult Mental Health Home Page
Adult Mental Health Home Page