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Graaf G, Palmer AN. Parent Ratings of Health Insurance Adequacy for Children with Emotional, Behavioral, or Developmental Problems. Acad Pediatr 2023; 23:1204-1212. [PMID: 36336328 PMCID: PMC10578061 DOI: 10.1016/j.acap.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. METHODS This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. RESULTS Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN = 63%) and all other parents with publicly insured children (non-CSHCN = 87%; CSHCN = 83%; CSHCN with EBDPs = 84%). CONCLUSIONS Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work (G Graaf), The University of Texas at Arlington, Arlington, Tex.
| | - Ashley N Palmer
- Department of Social Work (AN Palmer), Texas Christian University, Fort Worth, Tex
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2
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Solomon KT, Dasgupta K. State mental health insurance parity laws and college educational outcomes. JOURNAL OF HEALTH ECONOMICS 2022; 86:102675. [PMID: 36088863 DOI: 10.1016/j.jhealeco.2022.102675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/15/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
We examine the effect of the state-level full parity mental illness law implementation on mental illness among college-aged individuals and human capital accumulation in college. We utilize administrative data on completed suicides and grade point average (GPA) and survey data on reported mental illness days and decisions to disenroll from college between 1998 and 2008 in a difference-in-differences (DD) analysis to uncover the causal effects of state-level parity laws. We find that state-level parity law reduces youth suicide rate and propensity to report any poor mental health day, increases college GPA, and does not change the propensity to disenroll from college.
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Affiliation(s)
- Keisha T Solomon
- Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 North Broadway, Room 306, Baltimore, MD 21205, United States.
| | - Kabir Dasgupta
- Division of Consumer & Community Affairs of the Federal Reserve System, Board of Governors, 1850 K St NW, Washington, DC 20006, United States
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3
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Pham TV, Fetter AK, Wiglesworth A, Rey LF, Prairie Chicken ML, Azarani M, Riegelman A, Gone JP. Suicide interventions for American Indian and Alaska Native populations: A systematic review of prevention strategies, logics, and rationales. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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4
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Choi KR, Bhakta B, Knight EA, Becerra-Culqui TA, Gahre TL, Zima B, Coleman KJ. Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:9-16. [PMID: 34342287 PMCID: PMC8702444 DOI: 10.1097/dbp.0000000000000995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate. METHODS This retrospective, observational study used a random sample of children with ASD (3-17 yrs) who were members of a large integrated health care system in Southern California and referred for ABA between January 2016 and November 2018. From the 4145 children referred, a random stratified sample of 334 was selected to extract data from clinical reports over 24 months of services. The primary outcome measures were time in ABA and child adaptive behavior. RESULTS Thirteen percent of the sample never received ABA after referral. Of those who were referred for ABA, 66% initiated ABA and remained in services for 12 months, whereas less than half (46%) remained in services for 24 months. Having a history of special education was associated with longer time spent in ABA, whereas having a single parent was associated with discontinuation of ABA. A minority of children received a full ABA dose (28%), but the lowest functioning children still experienced clinically significant adaptive behavior gains after 24 months of ABA (p = 0.02). CONCLUSION In a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even in a context in which there is mandated commercial insurance coverage.
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Affiliation(s)
- Kristen R. Choi
- School of Nursing, University of California, Los Angeles, Los Angeles, California
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bhumi Bhakta
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Tracy A. Becerra-Culqui
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
| | - Teri L. Gahre
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
| | - Bonnie Zima
- Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Karen J. Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
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5
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Carney MH. The impact of mental health parity laws on birth outcomes. HEALTH ECONOMICS 2021; 30:748-765. [PMID: 33449426 DOI: 10.1002/hec.4217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 08/30/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Prior studies have found that poor mental health during pregnancy is associated with poor birth outcomes, but little is known about the ability of mental health care access and treatment to counteract these effects. I use a difference-in-differences strategy exploiting the staggered enactment of state mental health parity laws in 25 states from 1995 to 2002 to identify the impact of mental health care access on the probability of an adverse birth outcome. These state mental health parity laws are insurance mandates requiring coverage of mental health care be equivalent to physical health care. Using birth records, I find that, among the group of mothers most likely to have private insurance, introduction of a mental health parity law in a state decreased the probability of an adverse birth outcome. Furthermore, I find that the parity laws decreased the likelihood that a pregnant woman hospitalized for delivery would receive a mental illness diagnosis.
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Affiliation(s)
- Monica Harber Carney
- Department of Economics and Accounting, College of the Holy Cross, Worcester, Massachusetts, USA
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6
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Double-edged sword of federalism: variation in essential health benefits for mental health and substance use disorder coverage in states. HEALTH ECONOMICS POLICY AND LAW 2020; 16:170-182. [PMID: 31902388 DOI: 10.1017/s1744133119000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Affordable Care Act requires all insurance plans sold on health insurance marketplaces and individual and small-group plans to cover 10 Essential Health Benefits (EHB), including behavioral health services. Instead of applying a uniform EHB plan design, the Department of Health and Human Services let states define their own EHB plan. This approach was seen as the best balance between flexibility and comprehensiveness, and assumed there would be little state-to-state variation. Limited federal oversight runs the risk of variation in EHB coverage definitions and requirements, as well as potential divergence from standardized medical guidelines. We analyzed 112 EHB documents from all states for behavioral health coverage in effect from 2012 to 2017. We find wide variation among states in their EHB plan required-coverage, and divergence between medical-practice guidelines and EHB plans. These results emphasize consideration of federated regulation over health insurance coverage standards. Federal flexibility in states benefit design nods to state-specific policymaking-processes and population needs. However, flexibility becomes problematic if it leads to inadequate coverage that reduces access to critical health care services. The EHBs demonstrate an incomplete effort to establish appropriate minimum standards of coverage for behavioral health services.
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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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8
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Barry CL, Kennedy-Hendricks A, Mandell D, Epstein AJ, Candon M, Eisenberg M. State Mandate Laws for Autism Coverage and High-Deductible Health Plans. Pediatrics 2019; 143:e20182391. [PMID: 31092588 PMCID: PMC6564055 DOI: 10.1542/peds.2018-2391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Most states have passed insurance mandates requiring health plans to cover services for children with autism spectrum disorder (ASD). Research reveals that these mandates increased treated prevalence, service use, and spending on ASD-related care. As employer-sponsored insurance shifts toward high-deductible health plans (HDHPs), it is important to understand how mandates affect children with ASD in HDHPs relative to traditional, low-deductible plans. METHODS Insurance claims for 2008-2012 for children covered by 3 large US insurers (United Healthcare, Aetna, and Humana) available through the Health Care Cost Institute were used to compare the effects of mandates on ASD-related spending for children in HDHPs and traditional health plans. RESULTS Relative to children in traditional plans, mandates were associated with higher average monthly spending increases for children in HDHPs. Mandate-attributable spending differences between children enrolled in HDHPs relative to traditional plans were $77 for ASD-specific services (95% confidence interval [CI]: $10 to $144), $125 for outpatient health services (95% CI: $26 to $223), and $144 for all health services (95% CI: $36 to $253). These spending differentials were driven by differences in plan spending and not out-of-pocket (OOP) spending. CONCLUSIONS Spending on ASD-related services attributable to autism mandates was higher among children in HDHPs, but higher spending did not translate into a greater OOP burden. For families with consistently high health care expenditures on ASD-related services, high-deductible products may be worth considering in the context of mandate laws. Families in mandate states with children with ASD enrolled in HDHPs were able to increase service use without paying more OOP.
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Affiliation(s)
- Colleen L Barry
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland;
- Johns Hopkins Center for Mental Health and Addiction Policy Research, Baltimore, Maryland
- Leonard Davis Institute of Health Economics and
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins Center for Mental Health and Addiction Policy Research, Baltimore, Maryland
| | - David Mandell
- Leonard Davis Institute of Health Economics and
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | - Molly Candon
- Leonard Davis Institute of Health Economics and
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Matthew Eisenberg
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins Center for Mental Health and Addiction Policy Research, Baltimore, Maryland
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Coverage mandates and market dynamics: employer, insurer and patient responses to parity laws. HEALTH ECONOMICS POLICY AND LAW 2018; 15:173-195. [DOI: 10.1017/s1744133118000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractParity in coverage for mental health services has been a longstanding policy aim at the state and federal levels and is a regulatory feature of the Affordable Care Act. Despite the importance and legislative effort involved in these policies, evaluations of their effects on patients yield mixed results. I leverage the Employee Retirement Income Security Act and unique claims-level data that includes information on employers’ self-insurance status to shed new light in this area after the implementation of two state parity laws in 2007 and federal parity a few years later. My empirics reveal evidence of strategic avoidance on behalf of insurers in both states prior to the passage of state parity, as well as positive increases in mental health care utilization after parity laws are implemented – but context matters. Policy heterogeneity across states and strategic behaviors by employers and commercial insurers substantively shape the benefits that ultimately flow to patients. Insights from this research have broad relevance to ongoing health policy debates, particularly as states retain great discretion over many health coverage decisions and as federal policy continues to evolve.
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10
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Nathenson R, Richards MR. Do coverage mandates affect direct-to-consumer advertising for pharmaceuticals? Evidence from parity laws. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:321-336. [PMID: 29380108 DOI: 10.1007/s10754-018-9234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
Direct-to-consumer advertising (DTCA) for prescription drugs is a relatively unique feature of the US health care system and a source of tens of billions of dollars in annual spending. It has also garnered the attention of researchers and policymakers interested in its implications for firm and consumer behavior. However, few economic studies have explored the DTCA response to public policies, especially those mandating coverage of these products. We use detailed advertising expenditure data to assess if pharmaceutical firms increase their marketing efforts after the implementation of relevant state and federal health insurance laws. We focus on mental health parity statutes and related drug therapies-a potentially ripe setting for inducing stronger consumer demand. We find no clear indication that firms expect greater value from DTCA after these regulatory changes. DTCA appears driven by other considerations (e.g., product debut); however, it remains a possibility that firms respond to these laws through other, unobserved channels (e.g., provider detailing).
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Affiliation(s)
- Robert Nathenson
- University of Pennsylvania, 3440 Market Street Suite 560, Philadelphia, PA, 19146, USA.
| | - Michael R Richards
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End, Suite 1275, Nashville, 37203, TN, USA
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Kennedy-Hendricks A, Epstein AJ, Stuart EA, Haffajee RL, McGinty EE, Busch AB, Huskamp HA, Barry CL. Federal Parity and Spending for Mental Illness. Pediatrics 2018; 142:peds.2017-2618. [PMID: 30037977 PMCID: PMC6317554 DOI: 10.1542/peds.2017-2618] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Families of children with mental health conditions face heavy economic burdens. One of the objectives of the Mental Health Parity and Addiction Equity Act (MHPAEA) is to reduce the financial burden for those with intensive mental health service needs. Few researchers to date have examined MHPAEA's effects on children with mental health conditions and those with particularly high mental health expenditures. METHODS A difference-in-differences approach was used to compare commercially insured children ages 3 to 18 years (in 2008) who were continuously enrolled in plans newly subject to parity under MHPAEA to children continuously enrolled in plans never subject to parity. Data included inpatient, outpatient, and pharmaceutical claims for 2008-2012 from 3 national commercial insurers. We examined annual mental health service use and spending outcomes. RESULTS Among children with mental health conditions who were enrolled in plans subject to parity, parity was associated with $140 (95% confidence interval: -$196 to -$84) lower average annual out-of-pocket (OOP) mental health spending than expected given changes in the comparison group. Among children who were ≥85th percentile in total mental health spending, parity was associated with $234 (-$391 to -$76) lower average annual OOP mental health spending. CONCLUSIONS MHPAEA was associated with increased financial protection on average for children with mental health conditions and among those at the higher end of the spending distribution. However, estimated reductions in OOP spending were likely too modest to have substantially reduced financial burden on families of children with particularly high mental health expenditures.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Departments of Health Policy and Management and .,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew J. Epstein
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth A. Stuart
- Departments of Health Policy and Management and,Mental Health, and,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rebecca L. Haffajee
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emma E. McGinty
- Departments of Health Policy and Management and,Mental Health, and,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Alisa B. Busch
- McLean Hospital, Belmont, Massachusetts; and,Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Colleen L. Barry
- Departments of Health Policy and Management and,Mental Health, and,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Candon MK, Xie M, Mandell DS. Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder. Health Aff (Millwood) 2018; 36:1754-1761. [PMID: 28971920 DOI: 10.1377/hlthaff.2017.0515] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for mandates to children not subject to mandates using 2008-12 claims data from three national insurers. Increases in service use and spending attributable to state mandates were detected for all outcomes. Mandates were associated with a 3.4-percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of years since mandate implementation. These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance.
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Affiliation(s)
- Colleen L Barry
- Colleen L. Barry is the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and codirector of the Johns Hopkins Center for Mental Health and Addiction Policy Research, in Baltimore, Maryland
| | - Andrew J Epstein
- Andrew J. Epstein is scientific director of Medicus Economics, in Philadelphia, Pennsylvania
| | - Steven C Marcus
- Steven C. Marcus is a research associate professor in the School of Social Policy and Practice, University of Pennsylvania, in Philadelphia
| | - Alene Kennedy-Hendricks
- Alene Kennedy-Hendricks is an assistant scientist in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Molly K Candon
- Molly K. Candon is a postdoctoral fellow at the Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
| | - Ming Xie
- Ming Xie is a data analyst at the Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania
| | - David S Mandell
- David S. Mandell is director of the Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania
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Thalmayer AG, Harwood JM, Friedman S, Azocar F, Watson LA, Xu H, Ettner SL. The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Nonquantitative Treatment Limits for Specialty Behavioral Health Care. Health Serv Res 2018; 53:4584-4608. [PMID: 29740807 DOI: 10.1111/1475-6773.12871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess frequency, type, and extent of behavioral health (BH) nonquantitative treatment limits (NQTLs) before and after implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). DATA SOURCES Secondary administrative data for Optum carve-out and carve-in plans. STUDY DESIGN Cross-tabulations and "two-part" regression models were estimated to assess associations of parity period with NQTLs. DATA COLLECTION/EXTRACTION METHODS Optum provided four proprietary BH databases, including 2008-2013 data for 40 carve-out and 385 carve-in employers from Optum's claims processing databases and 2010 data from interviews conducted by Optum's parity compliance team with 49 carve-out employers. PRINCIPAL FINDINGS Preparity, carve-out plans required preauthorization for in-network inpatient/intermediate care; otherwise coverage was denied. Postparity, 73 percent would review later by request and half charged no penalty for late authorization. Outpatient visit authorization requirements virtually disappeared. For carve-out out-of-network inpatient/intermediate care, and for carve-ins, plans changed penalties to match medical service policies, but this did not necessarily lead to fewer requirements or lower penalties. CONCLUSION After 2011, MHPAEA was associated with the transformation of BH care management, including much less restrictive preauthorization requirements, especially for in-network care provided by carve-out plans.
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Affiliation(s)
| | - Jessica M Harwood
- Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Sarah Friedman
- Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, NV
| | | | | | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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14
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Doshi P, Tilford JM, Ounpraseuth S, Kuo DZ, Payakachat N. Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism? Matern Child Health J 2018; 21:351-366. [PMID: 27449784 DOI: 10.1007/s10995-016-2120-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The study investigated whether state mandates for private insurers to provide services for children with autism influence racial disparities in outcomes. Methods The study used 2005/2006 and 2009/2010 waves of the National Survey of Children with Special Health Care Needs. Children with a current diagnosis of autism were included in the sample. Children residing in 14 states and the District of Columbia that were not covered by the mandate in the 2005/2006 survey, but were covered in the 2009/2010 survey, served as the mandate group. Children residing in 32 states that were not covered by a mandate in either wave served as the comparison group. Outcome measures assessed included care quality, family economics, and child health. A difference-in-difference-in-differences (DDD) approach was used to assess the impact of the mandates on racial disparities in outcomes. Results Non-white children had less access to family-centered care compared to white children in both waves of data, but this difference was not apparent across mandate and comparison states as only the comparison states had significant differences. Parents of non-white children reported paying less in annual out-of-pocket expenses compared to parents of white children across waves and groups. DDD estimates did not provide evidence that the mandates had statistically significant effects on improving or worsening racial disparities for any outcome measure. Conclusions This study did not find evidence that state mandates on private insurers affected racial disparities in outcomes for children with autism.
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Affiliation(s)
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dennis Z Kuo
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nalin Payakachat
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham St, 522, Little Rock, AR, USA.
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15
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Hodgkin D, Horgan CM, Stewart MT, Quinn AE, Creedon TB, Reif S, Garnick DW. Federal Parity and Access to Behavioral Health Care in Private Health Plans. Psychiatr Serv 2018; 69:396-402. [PMID: 29334882 PMCID: PMC8508592 DOI: 10.1176/appi.ps.201700203] [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 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. METHODS A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care. RESULTS In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014. CONCLUSIONS Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.
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Affiliation(s)
- Dominic Hodgkin
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Constance M Horgan
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maureen T Stewart
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amity E Quinn
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Timothy B Creedon
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Reif
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah W Garnick
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Barry CL, Goldman HH, Huskamp HA. Federal Parity In The Evolving Mental Health And Addiction Care Landscape. Health Aff (Millwood) 2018; 35:1009-16. [PMID: 27269016 DOI: 10.1377/hlthaff.2015.1653] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The intent of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 is to eliminate differences between health insurance coverage of mental health and substance use disorder benefits and coverage of medical or surgical benefits. The Affordable Care Act significantly extended the reach of the Wellstone-Domenici law by applying it to new insurance markets. We summarize the evolution of legislative and regulatory actions to bring about federal insurance parity. We also summarize available evidence on how the Wellstone-Domenici law has contributed to addressing insurance discrimination; rectifying market inefficiencies due to adverse selection; and altering utilization, spending, and health outcomes for people with mental health and substance use disorders. In addition, we highlight important gaps in knowledge about how parity has been implemented, describe the groups still lacking parity-level coverage, and make recommendations on steps to improve the likelihood that the Wellstone-Domenici law will fulfill the aims of its architects.
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Affiliation(s)
- Colleen L Barry
- Colleen L. Barry is a professor in the Department of Health Policy and Management, with a joint appointment in the Department of Mental Health, at the Johns Hopkins Bloomberg School of Public Health, and codirector of the Johns Hopkins Center for Mental Health and Addiction Policy Research, in Baltimore, Maryland
| | - Howard H Goldman
- Howard H. Goldman is a professor of psychiatry at the University of Maryland School of Medicine, in Baltimore
| | - Haiden A Huskamp
- Haiden A. Huskamp is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
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Candon MK, Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Xie M, Mandell DS. The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder. Med Care 2018; 56:228-232. [PMID: 29287035 PMCID: PMC5811382 DOI: 10.1097/mlr.0000000000000863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan. METHODS Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes: (1) monthly spending on ASD-specific outpatient services; (2) monthly spending on ASD-specific inpatient services; and (3) quarterly spending on psychotropic medications. RESULTS The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child's level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1460 (P<0.001). In contrast, the effect was only $2 per month for a child in the fifth percentile (P<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications. CONCLUSIONS State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.
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Affiliation(s)
- Molly K Candon
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colleen L Barry
- Leonard Davis Institute of Health Economics
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Andrew J Epstein
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven C Marcus
- Leonard Davis Institute of Health Economics
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
| | | | - Ming Xie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David S Mandell
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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18
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Friedman SA, Thalmayer AG, Azocar F, Xu H, Harwood JM, Ong MK, Johnson LL, Ettner SL. The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Mental Health Financial Requirements among Commercial "Carve-In" Plans. Health Serv Res 2018; 53:366-388. [PMID: 27943277 PMCID: PMC5785319 DOI: 10.1111/1475-6773.12614] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Did mental health cost-sharing decrease following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA)? DATA SOURCE Specialty mental health copayments, coinsurance, and deductibles, 2008-2013, were obtained from benefits databases for "carve-in" plans from a national commercial managed behavioral health organization. STUDY DESIGN Bivariate and regression-adjusted analyses compare the probability of use and (conditional) level of cost-sharing pre- and postparity. An interaction term is added to compare differential levels of pre- and postparity cost-sharing changes for plans that were and were not already at parity pre-MHPAEA. FINDINGS Controlling for employer/plan characteristics, MHPAEA is associated with higher intermediate care copayments ($15.9) but lower outpatient ($2.6) copayments among in-network-only plans. Among plans with in- and out-of-network benefits, MHPAEA is associated with lower inpatient ($23.2) and outpatient ($2.5) copayments, but increases in inpatient and intermediate in-network and out-of-network coinsurance (about 1 percentage point). Among the few plans not at parity pre-MHPAEA, changes in use and level of cost-sharing associated with MHPAEA were more dramatic. CONCLUSION Mixed evidence that MHPAEA led to more generous mental health benefits may stem from the finding that many plans were already at parity pre-MHPAEA. Future policy focus in mental health may shift to slowing growth in cost-sharing for all health services.
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Affiliation(s)
- Sarah A. Friedman
- Department of Health Policy and ManagementFielding School of Public HealthUniversity of CaliforniaLos AngelesCA
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUCLALos AngelesCA
| | | | | | - Haiyong Xu
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUCLALos AngelesCA
| | - Jessica M. Harwood
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUCLALos AngelesCA
| | - Michael K. Ong
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUCLALos AngelesCA
- Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
| | | | - Susan L. Ettner
- Department of Health Policy and ManagementFielding School of Public HealthUniversity of CaliforniaLos AngelesCA
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUCLALos AngelesCA
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Kennedy-Hendricks A, Epstein AJ, Mandell DS, Candon MK, Marcus SC, Xie M, Barry CL. Effects of State Autism Mandate Age Caps on Health Service Use and Spending Among Adolescents. J Am Acad Child Adolesc Psychiatry 2018; 57:125-131. [PMID: 29413145 PMCID: PMC5806145 DOI: 10.1016/j.jaac.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many states with mandates requiring commercial insurers to cover autism spectrum disorder (ASD) health services specify upper age limits above which coverage is no longer mandated. It is unknown what effects these age caps have on health service use and spending among adolescents who have exceeded the age cap. METHOD Using administrative claims data from 3 national commercial insurers, a difference-in-differences approach was used to estimate effects of age caps on health service use and spending among adolescents with ASD. Statistical models compared changes in use and spending between those above versus below the age cap among individuals eligible versus ineligible for mandated coverage. The analytic sample included data from 2008 through 2012 on 7,845 individuals (151,976 person-months) ages 10 to 21 years in 11 states imposing mandate age caps going into effect during adolescence. RESULTS Age caps were associated with 4.2 percentage point (95% CI = -7.0, -1.5) lower probability of any ASD-specific service use in a month and $69 less (95% CI = -112, -$26) in average monthly spending on ASD-specific services than would have been expected given concomitant pre-post age cap differences among individuals in the same states who were never eligible for mandate-covered services. In addition, age caps were associated with $99 (95% CI = -$168, -$30) lower average monthly spending on all health care services. CONCLUSION Insurance mandates that include age caps going into effect during adolescence reduce health service use and spending among individuals with ASD during a critical phase of the life course.
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Affiliation(s)
| | | | - David S Mandell
- Leonard Davis Institute of Health Economics, Philadelphia; Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Molly K Candon
- Leonard Davis Institute of Health Economics, Philadelphia
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Ming Xie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Peterson E, Busch S. Achieving Mental Health and Substance Use Disorder Treatment Parity: A Quarter Century of Policy Making and Research. Annu Rev Public Health 2018; 39:421-435. [PMID: 29328871 DOI: 10.1146/annurev-publhealth-040617-013603] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 changed the landscape of mental health and substance use disorder coverage in the United States. The MHPAEA's comprehensiveness compared with past parity laws, including its extension of parity to plan management strategies, the so-called nonquantitative treatment limitations (NQTL), led to significant improvements in mental health care coverage. In this article, we review the history of this landmark legislation and its recent expansions to new populations, describe past research on the effects of this and other mental health/substance use disorder parity laws, and describe some directions for future research, including NQTL compliance issues, effects of parity on individuals with severe mental illness, and measurement of benefits other than mental health care use.
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Affiliation(s)
- Emma Peterson
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA; ,
| | - Susan Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA; ,
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21
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Douglas MD, Benevides TW, Carretta H. Analyzing State Autism Private Insurance Mandates for Allied Health Services: A Pilot Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:218-226. [PMID: 28874097 PMCID: PMC5772933 DOI: 10.1177/1539449217730355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to the prevalence, severity, and costs associated with autism spectrum disorders (ASDs), it has become a public health issue. In response, state governments have adopted ASD-specific private insurance mandates requiring coverage of ASD screening, diagnosis, and treatment. Despite rapid uptake of these laws, differences exist in the type and levels of coverage, especially for allied health services including occupational therapy. We piloted a structured legal research methodology to code ASD insurance mandates that impact allied health service provisions. State private insurance mandates were obtained from WestlawNext. A coding methodology was piloted on 14 states and included variables for age and service limits, treatments covered, and medical necessity. Coding methods were feasible and highly reliable among raters. Ten of 12 states had a coverage mandate, many with specific provisions for allied health providers. A full analysis of all 50 states is warranted to identify provisions affecting allied health providers serving individuals with ASD.
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Purtle J, Lê-Scherban F, Shattuck P, Proctor EK, Brownson RC. An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: protocol. Implement Sci 2017; 12:81. [PMID: 28651613 PMCID: PMC5485547 DOI: 10.1186/s13012-017-0613-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/20/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers' knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers. METHODS The study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon's Multiple Streams Framework, adapted to incorporate constructs from Aarons' Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed. DISCUSSION Study results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers' support for, and implementation of, evidence-based mental health policy interventions.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Paul Shattuck
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA
- A.J. Drexel Autism Institute, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Enola K Proctor
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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23
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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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Bitler MP, Carpenter CS. Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses. AMERICAN ECONOMIC JOURNAL. ECONOMIC POLICY 2016; 8:39-68. [PMID: 29527253 PMCID: PMC5844506 DOI: 10.1257/pol.20120298] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We examine the effects of state health insurance mandates requiring coverage of screening mammograms. We find evidence that mammography mandates significantly increased mammography screenings by 4.5-25 percent. Effects are larger for women with less than a high school degree in states that ban deductibles, a policy similar to a provision of federal health reform that eliminates cost-sharing for preventive care. We also find that mandates increased detection of early stage in-situ pre-cancers. Finally, we find a substantial proportion of the increased screenings were attributable to mandates that are not consistent with current recommendations of the American Cancer Society.
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Affiliation(s)
- Marianne P Bitler
- Department of Economics, University of California Davis, 1 Shields Avenue, Davis, CA 95616
| | - Christopher S Carpenter
- Department of Economics, Vanderbilt University, 2301 Vanderbilt Place, PMB 351819, Nashville, TN 37235-1819
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25
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Bitler MP, Carpenter CS. Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates. Health Serv Res 2016; 52:156-175. [PMID: 26989837 DOI: 10.1111/1475-6773.12477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women. DATA SOURCES Individual-level data on 600,000 women age 19-64 from the CDC's Behavioral Risk Factor Surveillance System. STUDY DESIGN Twenty-four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference-in-differences analysis comparing within-state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate. PRINCIPAL FINDINGS Difference-in-differences estimates indicated that the Pap test mandates significantly increased past 2-year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non-Hispanic white women. These effects are plausibly concentrated among insured women. CONCLUSIONS Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.
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Affiliation(s)
| | - Christopher S Carpenter
- Department of Economics, Vanderbilt University, Nashville, TN.,Department of Health Policy, Vanderbilt University, Nashville, TN.,Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN
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26
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Chang LV. THE EFFECT OF STATE INSURANCE MANDATES ON INFANT IMMUNIZATION RATES. HEALTH ECONOMICS 2016; 25:372-386. [PMID: 25773053 DOI: 10.1002/hec.3153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 10/31/2014] [Accepted: 12/30/2014] [Indexed: 06/04/2023]
Abstract
While US infant immunization rates have been increasing in the last 20 years, the cost of fully immunizing a child with all recommended vaccines has almost tripled. This is partly not only due to new additions in the list of recommended vaccines but also due to the use of new, safer, but more expensive technologies in vaccine production and distribution. In recent years, many states have mandated that recommended childhood vaccines be covered by private health insurance companies. Currently, there are 33 states with such a mandate. In this paper, I examine whether the introduction of mandates on private insurers affected immunization rates. Using state and time variation, I find that mandates increased the immunization rate for three vaccines--the diphtheria-tetanus-pertussis, polio, and measles-mumps-rubella vaccines--by about 1.8 percentage points. These results may provide a lower bound for the expected effect of the Affordable Care Act, which mandates coverage of childhood vaccines for all private insurers in the USA. I also find evidence that the mandates shifted a significant portion of vaccinations from publicly funded sources to private ones, with a decline in public health clinic visits and an increase in vaccinations at hospitals and doctor's offices.
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Andersen M. Heterogeneity and the effect of mental health parity mandates on the labor market. JOURNAL OF HEALTH ECONOMICS 2015; 43:74-84. [PMID: 26210944 PMCID: PMC4591173 DOI: 10.1016/j.jhealeco.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/09/2015] [Accepted: 06/30/2015] [Indexed: 06/07/2023]
Abstract
Health insurance benefit mandates are believed to have adverse effects on the labor market, but efforts to document such effects for mental health parity mandates have had limited success. I show that one reason for this failure is that the association between parity mandates and labor market outcomes vary with mental distress. Accounting for this heterogeneity, I find adverse labor market effects for non-distressed individuals, but favorable effects for moderately distressed individuals and individuals with a moderately distressed family member. On net, I conclude that the mandates are welfare increasing for moderately distressed workers and their families, but may be welfare decreasing for non-distressed individuals.
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Affiliation(s)
- Martin Andersen
- Department of Economics, Bryan School, University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402, United States.
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28
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Recommendation for mental health benefits legislation. Am J Prev Med 2015; 48:767-70. [PMID: 25998927 DOI: 10.1016/j.amepre.2015.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/05/2015] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
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29
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Effects of mental health benefits legislation: a community guide systematic review. Am J Prev Med 2015; 48:755-66. [PMID: 25998926 PMCID: PMC4700502 DOI: 10.1016/j.amepre.2015.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/05/2015] [Accepted: 01/30/2015] [Indexed: 11/21/2022]
Abstract
CONTEXT Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. EVIDENCE ACQUISITION Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. EVIDENCE SYNTHESIS Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. CONCLUSIONS Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence was limited for other mental health outcomes.
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Akosa Antwi Y, Moriya AS, Simon KI. Access to health insurance and the use of inpatient medical care: evidence from the Affordable Care Act young adult mandate. JOURNAL OF HEALTH ECONOMICS 2015; 39:171-87. [PMID: 25544401 DOI: 10.1016/j.jhealeco.2014.11.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 06/05/2014] [Accepted: 11/22/2014] [Indexed: 05/22/2023]
Abstract
The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent's private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion on inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent while mental illness visits increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.
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Affiliation(s)
- Yaa Akosa Antwi
- Department of Economics, Indiana University-Purdue University Indianapolis (IUPUI), United States.
| | - Asako S Moriya
- The School of Public and Environmental Affairs (SPEA), Indiana University, United States.
| | - Kosali I Simon
- The School of Public and Environmental Affairs (SPEA), Indiana University, United States; National Bureau of Economic Research (NBER), United States.
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Johnson RA, Danis M, Hafner-Eaton C. US state variation in autism insurance mandates: balancing access and fairness. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 18:803-14. [PMID: 24789870 DOI: 10.1177/1362361314529191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines how nations split decision-making about health services between federal and sub-federal levels, creating variation between states or provinces. When is this variation ethically acceptable? We identify three sources of ethical acceptability-procedural fairness, value pluralism, and substantive fairness-and examine these sources with respect to a case study: the fact that only 30 out of 51 US states or territories passed mandates requiring private insurers to offer extensive coverage of autism behavioral therapies, creating variation for privately insured children living in different US states. Is this variation ethically acceptable? To address this question, we need to analyze whether mandates go to more or less needy states and whether the mandates reflect value pluralism between states regarding government's role in health care. Using time-series logistic regressions and data from National Survey of Children with Special Health Care Needs, Individual with Disabilities Education Act, legislature political composition, and American Board of Pediatrics workforce data, we find that the states in which mandates are passed are less needy than states in which mandates have not been passed, what we call a cumulative advantage outcome that increases between-state disparities rather than a compensatory outcome that decreases between-state disparities. Concluding, we discuss the implications of our analysis for broader discussions of variation in health services provision.
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Affiliation(s)
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, USA
| | - Chris Hafner-Eaton
- Division of Science Policy and Science Liaison, National Institutes of Health, USA
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Wen H, Cummings JR, Hockenberry JM, Gaydos LM, Druss BG. State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation. JAMA Psychiatry 2013; 70:1355-62. [PMID: 24154931 PMCID: PMC4047825 DOI: 10.1001/jamapsychiatry.2013.2169] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. OBJECTIVE To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation. DESIGN, SETTING, AND PARTICIPANTS We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main source of data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment. INTERVENTIONS State-level SUD parity laws during the study period. MAIN OUTCOMES AND MEASURES State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. RESULTS The implementation of any SUD parity law increased the treatment rate by 9% (P < .001) in all specialty SUD treatment facilities and by 15% (P = .02) in facilities accepting private insurance. Full parity and parity only if SUD coverage is offered increased the SUD treatment rate by 13% (P = .02) and 8% (P = .04), respectively, in all facilities and by 21% (P = .03) and 10% (P = .04), respectively, in facilities accepting private insurance. CONCLUSIONS AND RELEVANCE We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.
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Affiliation(s)
- Hefei Wen
- Department of Health Policy and Management, Rollins School of Public Health
| | - Janet R. Cummings
- Department of Health Policy and Management, Rollins School of Public Health
| | | | - Laura M. Gaydos
- Department of Health Policy and Management, Rollins School of Public Health
| | - Benjamin G. Druss
- Department of Health Policy and Management, Rollins School of Public Health
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McConnell KJ. The effect of parity on expenditures for individuals with severe mental illness. Health Serv Res 2013; 48:1634-52. [PMID: 23557191 DOI: 10.1111/1475-6773.12058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To determine whether comprehensive behavioral health parity leads to changes in expenditures for individuals with severe mental illness (SMI), who are likely to be in greatest need for services that could be outside of health plans' traditional limitations on behavioral health care. DATA SOURCES/STUDY SETTING We studied the effects of a comprehensive parity law enacted by Oregon in 2007. Using claims data, we compared expenditures for individuals in four Oregon commercial plans from 2005 through 2008 to a group of commercially insured individuals in Oregon who were exempt from parity. STUDY DESIGN We used difference-in-differences and difference-in-difference-in-differences analyses to estimate changes in spending, and quantile regression methods to assess changes in the distribution of expenditures associated with parity. PRINCIPAL FINDINGS Among 2,195 individuals with SMI, parity was associated with increased expenditures for behavioral health services of $333 (95 percent CI $67, $615), without corresponding increases in out-of-pocket spending. The increase in expenditures was primarily attributable to shifts in the right tail of the distribution. CONCLUSIONS Oregon's parity law led to higher average expenditures for individuals with SMI. Parity may allow individuals with high mental health needs to receive services that may have been limited without parity regulations.
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Affiliation(s)
- K John McConnell
- Department of Emergency Medicine, Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
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Lang M. The impact of mental health insurance laws on state suicide rates. HEALTH ECONOMICS 2013; 22:73-88. [PMID: 22184054 DOI: 10.1002/hec.1816] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 08/25/2011] [Accepted: 10/26/2011] [Indexed: 05/31/2023]
Abstract
In the 1990s and early 2000s, a number of states passed laws requiring mental health benefits to be included in health insurance coverage. The variation in the characteristics and enactment date of the laws provides an opportunity to measure the impact of increasing access to mental health care on mental health outcomes, as evidenced by state suicide rates. In contrast with previous research, results show that when states enact laws requiring insurance coverage to include mental health benefits at parity with physical health benefits, the suicide rate decreases significantly by 5%. The findings are robust to a number of specifications and falsification tests.
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Affiliation(s)
- Matthew Lang
- Department of Economics, Xavier University, Cincinnati, Ohio 45207, USA.
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Hernandez EM, Uggen C. Institutions, Politics, and Mental Health Parity. SOCIETY AND MENTAL HEALTH 2012; 2:10.1177/2156869312455436. [PMID: 24353902 PMCID: PMC3864046 DOI: 10.1177/2156869312455436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mental health parity laws require insurers to extend comparable benefits for mental and physical health care. Proponents argue that by placing mental health services alongside physical health services, such laws can help ensure needed treatment and destigmatize mental illness. Opponents counter that such mandates are costly or unnecessary. The authors offer a sociological account of the diffusion and spatial distribution of state mental health parity laws. An event history analysis identifies four factors as especially important: diffusion of law, political ideology, the stability of mental health advocacy organizations and the relative health of state economies. Mental health parity is least likely to be established during times of high state unemployment and under the leadership of conservative state legislatures.
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Perry DF, Nicholson W, Christensen AL, Riley AW. A Public Health Approach to Addressing Perinatal Depression. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2011. [DOI: 10.1080/14623730.2011.9715657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gutman SA. Special issue: Effectiveness of occupational therapy services in mental health practice. Am J Occup Ther 2011; 65:235-7. [PMID: 21675328 DOI: 10.5014/ajot.2011.001339] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cokkinides V, Bandi P, Shah M, Virgo K, Ward E. The association between state mandates of colorectal cancer screening coverage and colorectal cancer screening utilization among US adults aged 50 to 64 years with health insurance. BMC Health Serv Res 2011; 11:19. [PMID: 21272321 PMCID: PMC3038893 DOI: 10.1186/1472-6963-11-19] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 01/27/2011] [Indexed: 12/17/2022] Open
Abstract
Background Several states in the US have passed laws mandating coverage of colorectal cancer (CRC) screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage). Methods We collected information on state mandates implemented by December 31, 2008 and used data on insured adults aged 50 and 64 years from the Behavioral Risk Factor Surveillance System between 2002 and 2008 to classify individual-level exposure to state mandates for at least 1 year. Multivariate logistic regression models (with state- and year- fixed effects, and patient demographic and socioeconomic characteristics) were used to estimate the effect of state mandates on recent endoscopy screening (either flexible sigmoidoscopy or colonoscopy during the past year). Results From 1999-2008, twenty-two states in the US, including the District of Columbia passed comprehensive laws requiring health insurance coverage of CRC screening including endoscopy tests. Residence in states with CRC screening coverage mandates in place for at least 1 year was associated with a 1.4 percentage point increase in the probability of utilization of recent endoscopy (i.e., 17.5% screening rates in those with mandates versus 16.1% in those without, Adjusted OR = 1.10, 95% CI: 1.02 - 1.20, p = 0.02). Conclusions The findings suggest a positive, albeit small, impact of state mandates on the use of recent CRC screening endoscopy among the target eligible population with health insurance. However, more research is needed to evaluate potential effects of mandates across health insurance types while including controls for other system-level factors (e.g. endoscopy and primary care capacity). National health insurance reform should strive towards a system that expands access to recommended CRC screening tests.
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Affiliation(s)
- Vilma Cokkinides
- Surveillance and Health Policy Research, American Cancer Society, Atlanta, USA.
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Barry CL, Huskamp HA, Goldman HH. A political history of federal mental health and addiction insurance parity. Milbank Q 2010; 88:404-33. [PMID: 20860577 DOI: 10.1111/j.1468-0009.2010.00605.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CONTEXT This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades. METHODS Twenty-nine structured interviews were conducted with key informants in the federal parity debate, including members of Congress and their staff; lobbyists for consumer, provider, employer, and insurance groups; and other key contacts. Historical documentation, academic research on the effects of parity regulations, and public comment letters submitted to the U.S. Departments of Labor, Health and Human Services, and Treasury before the release of federal guidance also were examined. FINDINGS Three factors were instrumental to the passage of this law: the emergence of new evidence regarding the costs of parity, personal experience with mental illness and addiction, and the political strategies adopted by congressional champions in the Senate and House of Representatives. CONCLUSIONS Challenges to implementing the federal parity policy warrant further consideration. This law raises new questions about the future direction of federal policymaking on behavioral health.
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Affiliation(s)
- Colleen L Barry
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD 21205, USA.
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40
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Smaldone A, Cullen-Drill M. Mental Health Parity Legislation. J Psychosoc Nurs Ment Health Serv 2010; 48:26-34. [DOI: 10.3928/02793695-20100730-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 05/27/2010] [Indexed: 11/20/2022]
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Busch SH, Barry CL. Does private insurance adequately protect families of children with mental health disorders? Pediatrics 2009; 124 Suppl 4:S399-406. [PMID: 19948605 PMCID: PMC2805472 DOI: 10.1542/peds.2009-1255k] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although private insurance typically covers many health care costs, the challenges faced by families who care for a sick child are substantial. These challenges may be more severe for children with special health care needs (CSHCN) with mental illnesses than for other CSHCN. Our objective was to determine if families of privately insured children who need mental health care face different burdens than other families in caring for their children. PATIENTS AND METHODS We used the 2005-2006 National Survey of Children With Special Health Care Needs (NS-CSHCN) to study privately insured children aged 6 to 17 years. We compared CSHCN with mental health care needs (N = 4918) to 3 groups: children with no special health care needs (n = 2346); CSHCN with no mental health care needs (n = 16250); and CSHCN with no mental health care need but a need for other specialty services (n = 7902). The latter group was a subset of CSHCN with no mental health care need. We used weighted logistic regression and study outcomes across 4 domains: financial burden; health plan experiences; labor-market and time effects; and parent experience with services. RESULTS We found that families of children with mental health care needs face significantly greater financial barriers, have more negative health plan experiences, and are more likely to reduce their labor-market participation to care for their child than other families. CONCLUSIONS Families of privately insured CSHCN who need mental health care face a higher burden than other families in caring for their children. Policies are needed to help these families obtain affordable, high-quality care for their children.
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Affiliation(s)
- Susan H Busch
- Division of Health Policy and Administration, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut 06520-8034, USA.
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Trivedi AN, Swaminathan S, Mor V. Insurance parity and the use of outpatient mental health care following a psychiatric hospitalization. JAMA 2008; 300:2879-85. [PMID: 19109116 PMCID: PMC4757896 DOI: 10.1001/jama.2008.888] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Mental health services are typically subject to higher cost sharing than other health services. In 2008, the US Congress enacted legislation requiring parity in insurance coverage for mental health services in group health plans and Medicare Part B. OBJECTIVE To determine the relationship between mental health insurance parity and the use of timely follow-up care after a psychiatric hospitalization. DESIGN, SETTING, AND POPULATION We reviewed cost-sharing requirements for outpatient mental health and general medical services for 302 Medicare health plans from 2001 to 2006. Among 43 892 enrollees in 173 health plans who were hospitalized for a mental illness, we determined the relation between parity in cost sharing and receipt of timely outpatient mental health care after discharge using cross-sectional analyses of all Medicare plans and longitudinal analyses of 10 plans that discontinued parity compared with 10 matched control plans that maintained parity. MAIN OUTCOME MEASURES Outpatient mental health visits within 7 and 30 days following a discharge for a psychiatric hospitalization. RESULTS More than three-quarters of Medicare plans, representing 79% of Medicare enrollees, required greater cost sharing for mental health care compared with primary or specialty care. The adjusted rate of follow-up within 30 days after a psychiatric hospitalization was 10.9 percentage points greater (95% confidence interval [CI], 4.6-17.3; P < .001) in plans with equivalent cost sharing for mental health and primary care compared with plans with mental health cost sharing greater than primary and specialty care cost sharing. The association of parity with follow-up care was increased for enrollees from areas of low income and less education. Rates of follow-up visits within 30 days decreased by 7.7 percentage points (95% CI, -12.9 to -2.4; P = .004) in plans that discontinued parity and increased by 7.5 percentage points (95% CI, 2.0-12.9; P = .008) among control plans that maintained parity (adjusted difference in difference, 14.2 percentage points; 95% CI, 4.5-23.9; P = .007). CONCLUSION Medicare enrollees in health plans with insurance parity for mental health and primary care have markedly higher use of clinically appropriate mental health services following a psychiatric hospitalization.
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Affiliation(s)
- Amal N Trivedi
- Department of Community Health, Warren Alpert Medical School at Brown University, Box G-S121, Providence, RI 02912, USA.
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Benefit limits for behavioral health care in private health plans. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2008; 36:15-23. [PMID: 19037721 DOI: 10.1007/s10488-008-0196-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
Abstract
Data from a nationally representative sample of private health plans reveal that special lifetime limits on behavioral health care are rare (used by 16% of products). However, most plans have special annual limits on behavioral health utilization; for example, 90% limit outpatient mental health and 93% limit outpatient substance abuse treatment. As a result, enrollees in the average plan face substantial out-of-pocket costs for long-lasting treatment: a median of $2,710 for 50 mental health visits, or $2,400 for 50 substance abuse visits. Plans' access to new managed care tools has not led them to stop using benefit limits for cost containment purposes.
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Robbins CJ, Rudsenske T, Vaughan JS. Private Equity Investment In Health Care Services. Health Aff (Millwood) 2008; 27:1389-98. [DOI: 10.1377/hlthaff.27.5.1389] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - James S. Vaughan
- Cain Brothers and Company, an investment banking firm based in New York City
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Busch SH, Barry CL. New Evidence on the Effects of State Mental Health Mandates. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2008; 45:308-22. [DOI: 10.5034/inquiryjrnl_45.03.308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
State mental health parity laws improve equity in private insurance coverage for mental and physical health services, but prior research shows no effect on service use. We study whether state parity differentially affects individuals by employer size since large firms are often exempt from state health mandates due to the Employee Retirement Income Security Act. We also examine whether state parity laws differentially affect use among individuals with low incomes or in poor mental health. We find that individuals in smaller firms are more likely to use services post-parity implementation and that this effect is concentrated among low-income individuals.
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