Massachusetts Health Reform Survey Finds Challenges in Access to Care for Mental Health and Substance Use Disorders

Tuesday, December 11, 2018

Massachusetts Health Reform Survey Finds Challenges in Access
to Care for Mental Health and Substance Use Disorders

Barriers to Medical Care Persist Despite Sustained Gains in Coverage

BOSTON (Dec. 11, 2018) – A survey on health insurance coverage, health care access, and affordability released today by the Blue Cross Blue Shield of Massachusetts Foundation found that a majority of adults who sought care for mental health or substance use disorders experienced difficulty obtaining that care, even among those with steady insurance coverage.

According to the 2018 Massachusetts Health Reform Survey, conducted earlier this year by the Urban Institute and Social Science Research Solutions, nearly 57 percent of adults age 19 to 64 who sought mental health or substance use disorder services had trouble finding a behavioral health provider who would see them, likely contributing to more than one-third of them going without needed behavioral health care.

“In a state where we have made such dramatic gains in coverage, it is disturbing that so many people with mental health and substance use conditions face these challenges in getting treatment.  Given the toll that these conditions take on individuals and their families, as well as their overall health, we must do better,” said Audrey Shelto, President of the Blue Cross Blue Shield of Massachusetts Foundation.

The periodic survey tracks trends in the health care system since the 2006 passage of Massachusetts’ landmark health reform law.  The latest survey, which polled 2,201 respondents from February to May, included for the first time measures of access to care for mental health and substance use disorder services.

The report issue brief and chart packs, along with other survey resources, can be found here.  Key findings from the survey include:

  • Massachusetts is sustaining the coverage gains that followed the 2006 health reform initiative. The survey found that 96 percent of adults had health insurance in 2018 and most (87.6 percent) maintained their coverage for the entire year.
  • Insurance coverage doesn’t guarantee access to health care generally or to mental health and substance use disorder services specifically. Almost half (46 percent) of insured adults reported difficulty obtaining health care in the past 12 months and more than a third of insured adults reported going without needed care over the past year.  Among insured adults who sought mental health or substance use disorder services, more than half (55 percent) reported difficulty obtaining mental health and/or substance use disorder care in the past 12 months and a third reported going without needed care for mental health and/or substance use disorders.
  • Insurance coverage doesn’t guarantee affordable care. More than 30 percent of insured adults reported having a problem with health care affordability in the past 12 months.  Among insured adults who sought mental health or substance use disorder services, more than 50 percent reported a problem with health care affordability in the past 12 months.
  • Emergency department (ED) use is higher among insured low-income and moderate-income adults and among insured adults who have sought mental health and substance use disorder services.
    • While less than 1 in 5 insured higher-income adults reported an ED visit in the last 12 months, over 40 percent of low income and almost a third of moderate income insured adults reported such a visit.
    • Insured adults who sought mental health and substance use disorder services were nearly twice as likely to have visited the ED (for any reason) as those who have not sought mental health and/or substance use disorder services; they were also four times more likely to have had three or more ED visits in the last year.

“This survey is an important tool in monitoring the positive effects of health reform in the Commonwealth and the persistent challenges to improving access and affordability,” said Sharon K. Long, Ph.D., a senior fellow at the Urban Institute and co-author of the survey report.  “With these new behavioral health measures we can continue to identify barriers to care and document the work that remains.”