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PubMed1990

Reining in mental health costs.

A leader in the management of mental health costs, Walter Afield says hospitals are no place for mentally ill people and substance abusers unless they are a danger to themselves or others. "Hospitals should do the right thing" and halt unnecessary inpatient stays, he said.

Florida↗
PubMed1996

Mental health matters.

Explore the source record for details and available documents.

Health Benefit Plans, Employee↗
PubMed1997

Issues in mental health care benefits: the costs of mental health parity.

This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers. When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable. The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states--Rhode Island, Maine, and New Hampshire--apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA). A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical" preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals. All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits.

Cost Sharing↗
PubMed1997

What benefits managers should know about the Mental Health Parity Act of 1996.

In consideration of the statutory requirements of the Mental Health Parity Act of 1996, the author stresses that benefits managers should consider three issues. First, the financial impact of the act should be minimal for most plans. Second, minimal compliance may require more extensive changes to the plan than originally anticipated. Finally, the process of compliance offers opportunity to examine broader issues of mental health coverage. The article explains what the act does and does not require. The article concludes with a presentation of a comparative analysis of the cost impact of the act on five prototype plan designs.

Employee Retirement Income Security Act↗
PubMed1997

Alternative insurance arrangements and the treatment of depression: what are the facts?

Using insurance claims data from nine large self-insured employers offering 26 alternative health benefit plans, we examine empirically how the composition and utilization for the treatment of depression vary under alternative organizational forms of insurance (indemnity, preferred provider organization networks, and mental health carve-outs), and variations in patient cost-sharing (copayments for psychotherapy and for prescription drugs). Although total outpatient mental health and substance abuse expenditures per treated individual do not vary significantly across insurance forms, the depressed outpatient is more likely to receive anti-depressant drug medications is preferred provider organizations and carve-outs than when covered by indemnity insurance. Those individuals facing higher copayments for psychotherapy are more likely to receive anti-depressant drug medications. For those receiving treatment, increases in prescription drug copayments tend to increase the share of anti-depressant drug medication costs accounted for by the newest (and more costly) generation of drugs, the selective serotonin reuptake inhibitors.

Antidepressive Agents↗
PubMed1997

ERISA preemption and its impact on behavioral health services.

Recently, mental health parity provisions were passed and incorporated retroactively into the Health Insurance Portability and Accountability Act (PL 104-191). Although limited, these provisions were instrumental in focusing national attention and debate on people's need for and right to behavioral health services. A handful of states have also passed parity provisions, but their full impact on the insurance market cannot be assessed. This is because a majority of plans are preempted from compliance with many state insurance mandates by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA is the primary obstacle to state behavioral health mandates, and it threatens the inclusion of behavioral health providers and settings in managed care plans integrating public and private healthcare systems. This article provides basic information on ERISA, its preemption clauses, and its impact on behavioral healthcare services.

Career Mobility↗
PubMed1997

Mental health parity compliance. Legal requirements and benefit design options.

Employers considering a response strategy to federal parity legislation may go as far as eliminating healthcare and mental health benefits altogether. Complying, however, could have higher payoff potential in performance results and in enhanced employee morale and relations. Reexamination of the value of behavioral health benefits should be considered in an organization's overall strategic plan. Our writer, a consultant to Wm. Mercer, Inc., defines plans which are potentially exempt from new mental health legislation, and examines the risks of "opting out," as well as the benefits of complying.

Cost Control↗
PubMed1997

Solutions for adverse selection in behavioral health care.

Health plans have incentives to discourage high-cost enrollees (such as persons with mental illness) from joining. Public policy to counter incentives created by adverse selection is difficult when managed care controls cost through methods that are largely beyond the grasp of direct regulation. In this article, the authors evaluate three approaches to dealing with selection incentives: risk adjustment, the carving out of benefits, and cost- or risk-sharing between the payer and the plan. Adverse selection is a serious problem in the context of managed care. Risk adjustment is not likely to help much, but carving out the benefit and cost-sharing are promising directions for policy.

Economic Competition↗
PubMed1991

Substance abuse coverage provided by employer medical plans.

In summary, substance abuse is a serious problem in America. In fact, a Gallup poll ranked drug use as the Nation's number one problem. As a rapidly accelerating component of health care costs, charges for alcohol and drug abuse treatment are helping to drive up medical care expenses. The substance abuse crisis is also affecting employers, both public and private, who are struggling to provide needed health benefits while controlling spiraling plan costs. Despite the upward pressure on health costs, the problem is so serious that there has been a steady increase in the incidence of coverage for substance abuse treatment in employer-provided medical care plans, to the point that virtually all plans now provide some benefits. Nevertheless, health plans typically cover substance abuse treatment on a more restrictive basis than other illnesses. This may change, however, as the interest in, and the need for, comprehensive substance abuse treatment benefits grows.

Data Collection↗