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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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Douglas MD, Bent Weber S, Bass C, Li C, Gaglioti AH, Benevides T, Heboyan V. Creation of a Longitudinal Legal Data Set to Support Legal Epidemiology Studies of Mental Health Insurance Legislation. Psychiatr Serv 2022; 73:265-270. [PMID: 34320828 DOI: 10.1176/appi.ps.202100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article describes policy surveillance methodology used to track changes in the comprehensiveness of state mental health insurance laws over 23 years, resulting in a data set that supports legal epidemiology studies measuring effects of these laws on mental health outcomes. METHODS Structured policy surveillance methods, including a coding protocol, blind coding of laws in 10% of states, and consensus meetings, were used to track changes in state laws from 1997 through 2019-2020. The legal database Westlaw was used to identify relevant statutes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definitions of mental health conditions, and enforcement-compliance. Points (range 0-7) were assigned to reflect the laws' comprehensiveness and aid interpretation of changes over time. RESULTS The search resulted in 147 coding time periods across 51 jurisdictions (50 states, District of Columbia). Intercoder consensus rates increased from 89% to 100% in the final round of blinded duplicate coding. Since 1997, average comprehensiveness scores increased from 1.31 to 3.82. In 1997, 41% of jurisdictions had a parity law, 28% mandated coverage, 31% defined mental health conditions, and 8% required state agency enforcement. In 2019-2020, 94% of jurisdictions had a parity law, 63% mandated coverage, 75% defined mental health conditions, and 29% required state enforcement efforts. CONCLUSIONS Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.
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Affiliation(s)
- Megan D Douglas
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Samantha Bent Weber
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Claire Bass
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Chaohua Li
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Anne H Gaglioti
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Teal Benevides
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Vahé Heboyan
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
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Heboyan V, Douglas MD, McGregor B, Benevides TW. Impact of Mental Health Insurance Legislation on Mental Health Treatment in a Longitudinal Sample of Adolescents. Med Care 2021; 59:939-946. [PMID: 34369459 PMCID: PMC8425633 DOI: 10.1097/mlr.0000000000001619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mental health insurance laws are intended to improve access to needed treatments and prevent discrimination in coverage for mental health conditions and other medical conditions. OBJECTIVES The aim was to estimate the impact of these policies on mental health treatment utilization in a nationally representative longitudinal sample of youth followed through adulthood. METHODS We used data from the 1997 National Longitudinal Survey of Youth and the Mental Health Insurance Laws data set. We specified a zero-inflated negative binomial regression model to estimate the relationship between mental health treatment utilization and law exposure while controlling for other explanatory variables. RESULTS We found that the number of mental health treatment visits declined as cumulative exposure to mental health insurance legislation increased; a 10 unit (or 10.3%) increase in the law exposure strength resulted in a 4% decline in the number of mental health visits. We also found that state mental health insurance laws are associated with reducing mental health treatments and disparities within at-risk subgroups. CONCLUSIONS Prolonged exposure to comprehensive mental health laws across a person's childhood and adolescence may reduce the demand for mental health visitations in adulthood, hence, reducing the burden on the payors and consumers. Further, as the exposure to the mental health law strengthened, the gap between at-risk subgroups was narrowed or eliminated at the highest policy exposure levels.
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Affiliation(s)
- Vahé Heboyan
- Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia, Augusta University, Augusta
| | - Megan D. Douglas
- Department of Community Health and Preventive Medicine, National Center for Primary Care
- Kennedy-Satcher Center for Mental Health Equity, Morehouse School of Medicine
| | | | - Teal W. Benevides
- Department of Occupational Therapy, College of Allied Health Sciences
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
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Shen Y, Noguchi H. Impacts of anticancer drug parity laws on mortality rates. Soc Sci Med 2021; 272:113714. [PMID: 33545495 DOI: 10.1016/j.socscimed.2021.113714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
This study investigates the impacts of anticancer drug parity laws on mortality rates in the United States using a difference-in-differences approach. Using data from 2004 to 2017 Compressed Mortality Files, we show that the anticancer drug parity laws reduce the mortality rate for head/neck malignant cancers but have no impact on malignant cancers of other types. We also rule out an insurance expansion channel that may influence the relationship between anticancer drug parity laws and malignant cancer mortality. Our results are robust to various specifications and falsification tests. Our findings imply that providing equal access to oral anticancer drugs is an effective tool for the prevention of premature mortality.
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Affiliation(s)
- Yichen Shen
- Graduate School of Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
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Li X, Ma J. Does Mental Health Parity Encourage Mental Health Utilization Among Children and Adolescents? Evidence from the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). J Behav Health Serv Res 2019; 47:38-53. [DOI: 10.1007/s11414-019-09660-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Haffajee RL, Mello MM, Zhang F, Busch AB, Zaslavsky AM, Wharam JF. Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services. Med Care 2019; 57:245-255. [PMID: 30807450 PMCID: PMC6423539 DOI: 10.1097/mlr.0000000000001076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act. OBJECTIVES To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers. RESEARCH DESIGN Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group. SUBJECTS Commercially insured enrollees aged 18-64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1-2 years postpolicy. MEASURES Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations. RESULTS Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, respectively. Corresponding annual mental health visits increased by 0.31 (0.12, 0.51) and 0.59 (0.37, 0.81) per enrollee. Difference-in-difference changes were larger for the highest baseline quartile mental health care utilizers [year 2: 0.76 visits per enrollee (0.14, 1.38); relative increase 10.07%] and spenders [year 2: $-2.28 (-3.76, -0.79); relative reduction 5.91%]. There were no significant difference-in-differences changes in emergency department visits or hospitalizations. CONCLUSIONS In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity.
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Affiliation(s)
- Rebecca L Haffajee
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Michelle M Mello
- Stanford Law School and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - Alisa B Busch
- McLean Hospital, Belmont
- Departments of Psychiatry
- Health Care Policy, Harvard Medical School, Boston, MA
| | | | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
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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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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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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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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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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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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Behavioral health services in separate CHIP programs on the eve of parity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 39:147-57. [PMID: 21461975 DOI: 10.1007/s10488-011-0340-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Children's Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children. This study examines behavioral health benefit design and management in separate CHIP programs on the eve of federal requirements for behavioral health parity. Even before parity implementation, many state CHIP programs did not impose service limits or cost sharing for behavioral health benefits. However, a substantial share of states imposed limits or cost sharing that might hinder access to care. The majority of states use managed care to administer behavioral health benefits. It is important to monitor how states adapt their programs to comply with parity.
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Assessing barriers to health insurance and threats to equity in comparative perspective: the Health Insurance Access Database. BMC Health Serv Res 2012; 12:107. [PMID: 22551599 PMCID: PMC3393626 DOI: 10.1186/1472-6963-12-107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 05/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Typologies traditionally used for international comparisons of health systems often conflate many system characteristics. To capture policy changes over time and by service in health systems regulation of public and private insurance, we propose a database containing explicit, standardized indicators of policy instruments. METHODS The Health Insurance Access Database (HIAD) will collect policy information for ten OECD countries, over a range of eight health services, from 1990-2010. Policy indicators were selected through a comprehensive literature review which identified policy instruments most likely to constitute barriers to health insurance, thus potentially posing a threat to equity. As data collection is still underway, we present here the theoretical bases and methodology adopted, with a focus on the rationale underpinning the study instruments. RESULTS These harmonized data will allow the capture of policy changes in health systems regulation of public and private insurance over time and by service. The standardization process will permit international comparisons of systems' performance with regards to health insurance access and equity. CONCLUSION This research will inform and feed the current debate on the future of health care in developed countries and on the role of the private sector in these changes.
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Abstract
Americans are living longer than ever before in history. With age comes an increased risk for chronic mental health disorders. About 1 in 8 baby boomers is expected to be diagnosed with Alzheimer disease, which will amount to some ten million members of this age cohort. The prevalence of mental health disorders among the elderly is often unrecognized. One in four older adults lives with depression, anxiety disorders, or other significant psychiatric disorders. Mental health disorders are frequently comorbid in older adults, occurring with a number of common chronic illnesses such as in diabetes, cardiac disease, and arthritis. The public is becoming more aware of the aging of the population and the difficulties that are exacerbated by unmet services and limited access to mental health services. This article describes policy issues related to chronic mental health disorders and the older population. Mental health parity, a recent policy issue occurring at the national level, is discussed first followed by workforce issues specific to the discipline of nursing.
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Affiliation(s)
- Karen M Robinson
- School of Nursing, University of Louisville, Louisville, KY 40292, 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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