Recorded presentation

Linda Elam, PhD, MPH, Kaiser Family Foundation, 1330 G Street, NW, Washington, DC 20005, 202.654.1347, lelam@kff.org

Prescription drugs are instrumental to the treatment of many illnesses, including depression. Drug treatment for depression underwent a significant change with the introduction of selective serotonin reuptake inhibitors (SSRIs) and other newer agents in the late 1980s and early 1990s, and this study investigates both access to antidepressants in general, and access to SSRIs and other newer agents as compared to the older tricyclic antidepressants (TCAs). Using data from the 1996 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of health care use and spending, patterns of outpatient access to antidepressant prescription drugs based on insurance coverage, particularly as they relate to race and ethnicity, were explored, using a study population comprising those between the ages of 18-64, either uninsured or covered by private insurance or Medicaid, with at least one ambulatory health care visit. Compared to those with insurance, the uninsured were 47% less likely to receive any antidepressant and black patients were 47% less likely than white patients to receive an antidepressant, after controlling for other factors. Additionally, older age, female sex, unemployment and fair to poor perceived mental health were all associated with 41-55% increases in receipt of antidepressant medication after adjustment. When SSRI use was compared to TCA use, blacks were 65% less likely than whites, the older group was 40% less likely than the younger group and women were 67% more likely than men to receive an SSRI. Adding other newer agents to the analysis did not change most findings significantly, but patient sex no longer had an effect on drug type access. Hispanic/Latino ethnicity was not significant in any of the adjusted models. These findings indicate that there are sometimes large differences in access to antidepressant drugs, and in access to preferred drug types, by factors for which there are no clinical justifications, including insurance coverage, race and other demographic characteristics, raising issues of treatment quality and distributional equity. This study adds to the literature documenting the importance of health insurance to health care access. It also provides further evidence of disparities in health care quality and treatment by race, and of the effects that non-clinical characteristics can have on the diffusion of technology in medical care.

Learning Objectives:

• At the conclusion of this session, attendees should be able to describe the effect of race and uninsurance on access to antidepressant medications. In addition, they should be able to differentiate between access to any antidepressant and access to older vs. newer agents.

Keywords: Prescription Drug Use Patterns, Insurance-Related Barriers

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation