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Mariot EAS, Barbas S, Nunes R. Enforcing the right to health in private health systems through Judicialization what can we learn from the scoping review of the cross-national perspective? Health Policy 2024; 145:105096. [PMID: 38810312 DOI: 10.1016/j.healthpol.2024.105096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Private sector acting in healthcare does not remove the public nature of a health system, nor mitigate the right to health as a human right. METHODS This scoping review aims to answer the question: what factors influence the pattern of lawsuits seeking to enforce the right to health in private healthcare systems? The search was carried out in Pubmed, SciELO, DOAJ and Scopus. RESULTS Out of 464 articles found, after inclusion and exclusion criteria, 30 articles were included. The survey covered 36 different countries and four main factors were identified. The socioeconomic context, the health system model, the incorporation of the right to health in legislation, and the model of regulation of private health. CONCLUSIONS Understanding these patterns help understanding the difficulties of implementing and guaranteeing universal health. Health systems must be based on responsibility, solidarity, equity, and distributive justice, since the sum of these values generates mutualism. Judicial decision-making regarding to health access must be reasoned on equity and distributive justice, scientific evidence and ethical factors. Even private health systems must be funded in a well-defined ethical platform and social moral valuation.
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Affiliation(s)
| | | | - Rui Nunes
- University of Porto Faculty of Medicine, Portugal
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Pilar M, Purtle J, Powell BJ, Mazzucca S, Eyler AA, Brownson RC. An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses. Community Ment Health J 2023; 59:122-131. [PMID: 35689717 PMCID: PMC9188272 DOI: 10.1007/s10597-022-00991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/24/2022] [Indexed: 01/09/2023]
Abstract
Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses- major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA.
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Amy A Eyler
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
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Douglas MD, Bent Weber S, Bass C, Li C, Gaglioti AH, Benevides T, Heboyan V. Creation of a Longitudinal Legal Data Set to Support Legal Epidemiology Studies of Mental Health Insurance Legislation. Psychiatr Serv 2022; 73:265-270. [PMID: 34320828 DOI: 10.1176/appi.ps.202100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article describes policy surveillance methodology used to track changes in the comprehensiveness of state mental health insurance laws over 23 years, resulting in a data set that supports legal epidemiology studies measuring effects of these laws on mental health outcomes. METHODS Structured policy surveillance methods, including a coding protocol, blind coding of laws in 10% of states, and consensus meetings, were used to track changes in state laws from 1997 through 2019-2020. The legal database Westlaw was used to identify relevant statutes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definitions of mental health conditions, and enforcement-compliance. Points (range 0-7) were assigned to reflect the laws' comprehensiveness and aid interpretation of changes over time. RESULTS The search resulted in 147 coding time periods across 51 jurisdictions (50 states, District of Columbia). Intercoder consensus rates increased from 89% to 100% in the final round of blinded duplicate coding. Since 1997, average comprehensiveness scores increased from 1.31 to 3.82. In 1997, 41% of jurisdictions had a parity law, 28% mandated coverage, 31% defined mental health conditions, and 8% required state agency enforcement. In 2019-2020, 94% of jurisdictions had a parity law, 63% mandated coverage, 75% defined mental health conditions, and 29% required state enforcement efforts. CONCLUSIONS Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.
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Affiliation(s)
- Megan D Douglas
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Samantha Bent Weber
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Claire Bass
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Chaohua Li
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Anne H Gaglioti
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Teal Benevides
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Vahé Heboyan
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
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Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors. J Gen Intern Med 2021; 36:3103-3112. [PMID: 33527189 PMCID: PMC7849617 DOI: 10.1007/s11606-020-06539-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022]
Abstract
Migraine affects over 40 million Americans and is the world's second most disabling condition. As the majority of medical care for migraine occurs in primary care settings, not in neurology nor headache subspecialty practices, healthcare system interventions should focus on primary care. Though there is grade A evidence for behavioral treatment (e.g., biofeedback, cognitive behavioral therapy (CBT), and relaxation techniques) for migraine, these treatments are underutilized. Behavioral treatments may be a valuable alternative to opioids, which remain widely used for migraine, despite the US opioid epidemic and guidelines that recommend against them. Identifying and removing barriers to the use of headache behavioral therapy could help reduce the disability as well as the personal and social costs of migraine. These techniques will have their greatest impact if offered in primary care settings to the lower socioeconomic status groups at greatest risk for migraine. We review the societal and cultural challenges that impose barriers to optimal use of non-pharmacological treatment services. These barriers include insufficient knowledge of migraine/headache behavioral treatments and insufficient availability of clinicians trained in non-pharmacological treatment delivery; limited access in underserved communities; financial burden; and stigma associated with both headache and mental health diagnoses and treatment. For each barrier, we discuss potential approaches to minimizing its effect and thus enhancing non-pharmacological treatment utilization.Case ExampleA 25-year-old graduate student with a prior history of headaches in college is attending school in the evenings while working a full-time job. Now, his headaches have significant nausea and photophobia. They are twice weekly and are disabling enough that he is unable to complete homework assignments. He does not understand why the headaches occur on Saturdays when he pushes through all week to get through his examinations that take place on Friday evenings. He tried two different migraine preventive medications, but neither led to the 50% reduction in headache days his doctor had hoped for. His doctor had suggested cognitive behavioral therapy (CBT) before initiating the medications, but he had been too busy to attend the appointments, and the challenges in finding an in-network provider proved difficult. Now with the worsening headaches, he opted for the CBT and by the fifth week had already noted improvements in his headache frequency and intensity.
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Wen H, Druss BG, Saloner B. Self-Help Groups And Medication Use In Opioid Addiction Treatment: A National Analysis. Health Aff (Millwood) 2021; 39:740-746. [PMID: 32364856 DOI: 10.1377/hlthaff.2019.01021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Self-help groups and medications (buprenorphine, methadone, and naltrexone) both play important roles in opioid addiction treatment. The relative use of these two treatment modalities has not been characterized in a national study. Using national treatment data, we found that self-help groups were rarely provided in conjunction with medication treatment: Among all adult discharges from opioid addiction treatment in the period 2015-17, 10.4 percent used both self-help groups and medications, 29.2 percent used only medications, 29.8 percent used only self-help groups, and 30.5 percent used neither self-help groups nor medications. Use of self-help groups without medication is most common in residential facilities, among those with criminal justice referrals, and among uninsured or privately insured patients, as well as in the South and West regions of the US. These subgroups may be important targets for future efforts to identify and overcome barriers to medication treatment and create multimodal paths to recovery.
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Affiliation(s)
- Hefei Wen
- Hefei Wen ( hefei_wen@hphci. harvard. edu ) is a faculty member in the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts
| | - Benjamin G Druss
- Benjamin G. Druss is the Rosalynn Carter Chair and a professor in the Department of Health Policy and Management, Emory University Rollins School of Public Health, in Atlanta, Georgia
| | - Brendan Saloner
- Brendan Saloner is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
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Abstract
Despite a series of federal laws aimed at ensuring parity in insurance coverage of treatment for mental health and general health conditions, patients with mental disorders continue to face discrimination by insurers. This inequity is often due to overly restrictive utilization review criteria that fail to conform to accepted professional standards. A recent class action challenge to the practices of the largest U.S. health insurer may represent an important step forward in judicial enforcement of parity laws. Rejecting the insurer's guidelines for coverage determinations as inconsistent with usual practices, the court enunciated eight principles that defined accepted standards of care.
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Affiliation(s)
- Paul S Appelbaum
- Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, Department of Psychiatry, Columbia University, New York (Appelbaum); National Council for Behavioral Health, Columbia, Missouri (Parks). Paul S. Appelbaum, M.D., is editor of this column
| | - Joseph Parks
- Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, Department of Psychiatry, Columbia University, New York (Appelbaum); National Council for Behavioral Health, Columbia, Missouri (Parks). Paul S. Appelbaum, M.D., is editor of this column
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PURTLE JONATHAN, LÊ‐SCHERBAN FÉLICE, WANG XI, SHATTUCK PAULT, PROCTOR ENOLAK, BROWNSON ROSSC. State Legislators' Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels. Milbank Q 2019; 97:1200-1232. [PMID: 31710152 PMCID: PMC6904266 DOI: 10.1111/1468-0009.12431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Policy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators' opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators' stigma toward people with mental illness could increase their support for state behavioral health parity laws CONTEXT: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators' fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators' fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support. METHODS We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators' fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression. FINDINGS Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL. CONCLUSIONS Legislators' mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.
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Affiliation(s)
| | | | - XI WANG
- PolicyLab, Children's Hospital of Philadelphia
| | - PAUL T. SHATTUCK
- Dornsife School of Public HealthDrexel University
- A.J. Drexel Autism InstituteDrexel University
| | - ENOLA K. PROCTOR
- Center for Mental Health Services ResearchBrown School at Washington University in St. Louis
| | - ROSS C. BROWNSON
- Prevention Research Center in St. LouisBrown at Washington University in St. Louis
- Division of Public Health Sciences and Alvin J. Siteman Cancer CenterWashington University School of Medicine, Washington University in St. Louis
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Callaghan T, Sylvester S. Autism spectrum disorder, politics, and the generosity of insurance mandates in the United States. PLoS One 2019; 14:e0217064. [PMID: 31125366 PMCID: PMC6534322 DOI: 10.1371/journal.pone.0217064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/03/2019] [Indexed: 11/19/2022] Open
Abstract
The study of Autism Spectrum Disorder (ASD) in the United States has identified a growing prevalence of the disorder across the country, a high economic burden for necessary treatment, and important gaps in insurance for individuals with autism. Confronting these facts, states have moved quickly in recent years to introduce mandates that insurers provide coverage for autism care. This study analyzes these autism insurance mandates and demonstrates that while states have moved swiftly to introduce them, the generosity of the benefits they mandate insurers provide varies dramatically across states. Furthermore, our research finds that controlling for policy need, interest group activity, economic circumstances, the insurance environment, and other factors, the passage of these mandates and differences in their generosity are driven by the ideology of state residents and politicians–with more generous benefits in states with more liberal citizens and increased Democratic control of state government. We conclude by discussing the implications of these findings for the study of health policy, politics, and autism in America.
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Affiliation(s)
- Timothy Callaghan
- Department of Health Policy and Management, Texas A&M University, School of Public Health, College Station, Texas, United States of America
- * E-mail:
| | - Steven Sylvester
- Department of History and Political Science, Utah Valley University, Orem, Utah, United States of America
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Huskamp HA, Samples H, Hadland SE, McGinty EE, Gibson TB, Goldman HH, Busch SH, Stuart EA, Barry CL. Mental Health Spending and Intensity of Service Use Among Individuals With Diagnoses of Eating Disorders Following Federal Parity. Psychiatr Serv 2018; 69:217-223. [PMID: 29137561 PMCID: PMC5794569 DOI: 10.1176/appi.ps.201600516] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Mental Health Parity and Addiction Equity Act (MHPAEA) was intended to eliminate differences in insurance coverage for mental health and substance use disorder services and medical-surgical care. No studies have examined mental health service use after federal parity implementation among individuals with diagnoses of eating disorders, for whom financial access to care has often been limited. This study examined whether MHPAEA implementation was associated with changes in use of mental health services and spending in this population. METHODS Using Truven Health MarketScan data from 2007 to 2012, this study examined trends in mental health spending and intensity of use of specific mental health services (inpatient days, total outpatient visits, psychotherapy visits, and medication management visits) among individuals ages 13-64 with a diagnosis of an eating disorder (N=27,594). RESULTS MHPAEA implementation was associated with a small increase in total mental health spending ($1,271.92; p<.001) and no change in out-of-pocket spending ($112.99; p=.234) in the first year after enforcement of the parity law. The law's implementation was associated with an increased number of outpatient mental health visits among users, corresponding to an additional 5.8 visits on average during the first year (p<.001). This overall increase was driven by an increase in psychotherapy use of 2.9 additional visits annually among users (p<.001). CONCLUSIONS MHPAEA implementation was associated with increased intensity of outpatient mental health service use among individuals with diagnoses of eating disorders but no increase in out-of-pocket expenditures, suggesting improvements in financial protection.
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Affiliation(s)
- Haiden A Huskamp
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Hillary Samples
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Scott E Hadland
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Emma E McGinty
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Teresa B Gibson
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Howard H Goldman
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Susan H Busch
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Elizabeth A Stuart
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
| | - Colleen L Barry
- Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Gibson is with Truven Health Analytics Inc., Ann Arbor, Michigan. Dr. Samples is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York. Dr. McGinty, Dr. Stuart, and Dr. Barry are with the Department of Health Policy and Management and with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Hadland is with the Department of Pediatrics, Boston University School of Medicine, and the Department of Medicine, Children's Hospital Boston, Boston. Dr. Goldman is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Busch is with the Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
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Purtle J, Borchers B, Clement T, Mauri A. Inter-Agency Strategies Used by State Mental Health Agencies to Assist with Federal Behavioral Health Parity Implementation. J Behav Health Serv Res 2017; 45:516-526. [PMID: 29247374 DOI: 10.1007/s11414-017-9581-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Purtle
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Benjamin Borchers
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA, 19104, USA
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Stuart EA, McGinty EE, Kalb L, Huskamp HA, Busch SH, Gibson TB, Goldman H, Barry CL. Increased Service Use Among Children With Autism Spectrum Disorder Associated With Mental Health Parity Law. Health Aff (Millwood) 2017; 36:337-345. [PMID: 28167724 PMCID: PMC8320748 DOI: 10.1377/hlthaff.2016.0824] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care services for children with autism spectrum disorder are often expensive and frequently not covered under private health insurance. The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was viewed as a possible means of improving access by eliminating differences between behavioral health and medical/surgical benefits. We examined whether the legislation was associated with increased use of and spending on mental health care and functional services for children with autism spectrum disorder compared to the period prior to implementation of the law. We used nationwide health insurance commercial group claims data to examine trends in service use and spending among children with autism spectrum disorder before and after implementation of the law. For such children, implementation was associated with increased use of both mental health and non-mental health services. These increases in use were not associated with higher out-of-pocket spending, which suggests that the law improved financial protection for families.
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Affiliation(s)
- Elizabeth A Stuart
- Elizabeth A. Stuart is associate dean for education, a professor in the Departments of Mental Health, Biostatistics, and Health Policy and Management, and codirector of the Center for Mental Health and Addiction Policy Research, all at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Emma E McGinty
- Emma E. McGinty is an assistant professor in the Departments of Health Policy and Management and Mental Health and Core Faculty of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health
| | - Luther Kalb
- Luther Kalb is a doctoral student in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health
| | - Haiden A Huskamp
- Haiden A. Huskamp is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
| | - Susan H Busch
- Susan H. Busch is a professor of public health and chair of the Department of Health Policy and Management, Yale University School of Public Health, in New Haven, Connecticut
| | - Teresa B Gibson
- Teresa B. Gibson is senior director at Truven Health Analytics in Ann Arbor, Michigan
| | - Howard Goldman
- Howard Goldman is a professor in the Department of Psychiatry, University of Maryland School of Medicine, in Baltimore
| | - Colleen L Barry
- Colleen L. Barry is the Fred and Julie Soper Professor and chair of the Department of Health Policy and Management and codirector of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health
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