Behavioral Health, Physical Health Worsen Among Women, Children

While many health behaviors in women of reproductive age and children have improved in recent years, behavioral health and physical health have declined and uninsurance rose, according to a UnitedHealth Group America’s Health Rankings report.

The report found that in 2019 almost 13 percent of women who were of reproductive age—approximately 7.2 million people between the ages of 18 and 44—were uninsured.

Insurance rates varied widely by state. In the state of Texas, over a quarter of women in this population were uninsured (26.3 percent). In the District of Columbia, the uninsurance rate among women of reproductive age was 2.5 percent.

Nearly six percent of children (5.7 percent) were uninsured in 2019. That share equals approximately 4.4 million kids. Almost 13 percent of the children in Texas did not have health insurance coverage, whereas in Massachusetts 1.5 percent of children were uninsured.

Overall, 11.6 million women and children were uninsured in 2019.

Preventive care utilization seemed to be strong among both patient populations. Nationally, almost three out of four women of reproductive age (73.2 percent) had experienced a preventive care service from 2018 to 2019.

Over eight out of ten Black women and six out of ten Hispanic women completed a preventive care service during the study period. Women with a college degree were more likely to receive preventive care, compared to women who graduated before college. 

Income was also a critical factor, with 77.3 percent of women with a salary of $70,000 or more reporting that they had received preventive care services. In contrast, 70.4 percent of women with incomes under $25,000 could say the same.

Among children, eight out of every ten participants reported experiencing one or more preventive care visits from 2019 to 2020.

Whereas well-woman visits increased over time from 2016 to 2019, the prevalence of child wellness visits declined two percentage points during that timeframe. While two percent may seem small, it was a significant change that impacted almost 1.3 million children.

Although preventive care utilization is fairly strong among women and children, these populations are also experiencing severe mental, behavioral, and physical healthcare outcomes.

The maternal mortality rate jumped 16 percent from 2018 to 2019. From 2017 to 2019, there were 6.6 maternal deaths per 1,000 births, which amounted to74,255 incidences—including ICU admissions, ruptured uteruses, or other procedures.

The report identified that many health behaviors saw a positive change during the report’s timeframe, but behavioral health and physical health trends were largely negative.

Health behaviors that improved included tobacco use which dropped 30 percent, smoking which declined seven percent, and teen births which dropped four percent.

But physical health worsened, with the rate of obesity increasing by nine percent and low birthweight increasing four percent.

Behavioral health also demonstrated poor results, revealing that the pre-pandemic mental health and behavioral health epidemic persists today. Frequent mental distress rose 14 percent and drug deaths rose by 24 percent.

Anxiety among children rose 21 percent between the periods of 2017 to 2018 and 2019 to 2020. The suicide rate among teenagers is 26 percent higher between the years of 2014 to 2016 and 2017 to 2019.

These metrics may provide payers with a backdrop for the results of their quality measures among members who are women and children.

Payers have employed numerous strategies to support the nation’s access to mental and behavioral healthcare. Employers have started covering more preventive care services, building collaborative care models, leveraging employee assistance programs, and tracking member outcomes in order to diminish the impact of this epidemic on their workforce.

Meanwhile, health insurers have been changing the culture within their own companies around mental and behavioral healthcare conditions. Highmark Health employees initiated a grassroots movement to be more open about substance abuse and the company supported that effort, establishing an employee group to champion substance abuse care and reduce stigma.

However, physical health is also suffering as the nation wrestles with the coronavirus pandemic. Obesity continues to be one of the top eight most expensive chronic conditions in America, alongside conditions such as cancer and heart disease.

In response, health insurers and employers are developing hybrid in-person and virtual wellness models. But employers are investing more funds in addressing mental health needs and seem to be withdrawing from the traditional wellness programming and incentives models that were once central to their wellness strategies.