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PubMed2002

Trends in mental health insurance benefits and out-of-pocket spending.

BACKGROUND: Insurance benefits can have a large effect on whether one is able to access health care services. Mental health and substance abuse (MHSA) insurance coverage has typically been less generous than that of general health services. AIMS OF THE STUDY: This paper examines trends in the generosity of private insurance benefits for mental health (MH) services in the United States from 1987 to 1996. The paper estimates the benefit-induced change in insurance payments for MH services that would have been made by typical health plans between 1987 and 1996 holding constant utilization of individuals at the 1987 level so that the changes in effective benefits could be isolated. METHODS: Trends in mental health benefits were measured using two nationally representative household surveys of the U.S. civilian non-institutionalized population, the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). Data on utilization and expenditures from the NMES/MEPS were used to simulate what the average person would have paid out-of-pocket under typical insurance plans in 1987 and in 1996. RESULTS: The study finds that limits on MH coverage, such as limits on reimbursed days of care, became more prevalent from 1987 to 1996, but that consumer cost-sharing rates declined. The simulations indicate that private insurance would have paid for a lower proportion of total spending in 1996 (60.1 percent) as compared to 1987 (65.8 percent). DISCUSSION: Despite the fact that limits on mental health services became more prevalent over the time-period evaluated, out-of-pocket expenditures did not increase as significantly because there was a corresponding increase in coinsurance covered by health plans. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Trends in plan design negatively affected those with high costs who are likely to surpass their limits and positively affected coverage for those with minimal use due to lower cost-sharing. These trends also indicate that persons in the most need, those with high utilization, particularly of inpatient care, experienced a decline in coverage while those with less intensive needs may have experienced a slight increase. IMPLICATIONS FOR HEALTH POLICIES: Out-of-pocket spending in both years of the study was substantial suggesting that improved health care coverage, such as that mandated in parity legislation, could improve access to care for persons needing mental health treatment. IMPLICATION FOR FURTHER RESEARCH: Additional research is needed to understand how trends in out-of-pocket spending and insurance benefits have influenced access to care.

Adolescent↗
PubMed2003

Medicare mental health coverage.

Medicare generally covers less than half the cost of mental health-care services. In order for you to best help your clients with mental health-care needs, it is critical to understand Medicare's mental health benefits and gaps. In this brief, we present an overview of mental health coverage and payment policies, including consumers' costs and their rights to appeal denials of payment.

Aged↗
PubMed2002

Perspectives: parity--prelude to a fifth cycle of reform.

BACKGROUND: Based on 2000 Carl Taube Lecture at the NIMH Mental Health Economics Meeting. AIMS OF THE STUDY: This perspective article examines the relationship between a policy of parity in financing mental health services and the future of reform in service delivery. METHODS: Applying theories of static and dynamic efficiency to an understanding of parity and the evolution of mental health services, drawing upon Burton Weisbrod s concept of the health care quadrilemma . RESULTS: Each of four cycles of reform in mental health services have contended with issues of static and dynamic efficiency. Each cycle was associated with static efficiency in the management and financing of services, and each was associated with a set of new treatment technologies intended to improve dynamic efficiency. Each reform proved ultimately unsuccessful primarily because of the failure of the treatment technologies to prevent future patient chronicity or to achieve sustained recovery. Recent advances in treatment technology and management of care can permit an unprecedented level of efficiency consistent with a policy of improved access to mainstream health and social welfare resources, including insurance coverage. This policy of so-called financing parity can improve current mental health service delivery, but it may also portend a future fifth cycle of reform. If new technologies continue to advance as full technologies - simple to deliver and producing true recovery - and mainstream resources are made available, then the specialty mental health services may contract dramatically in favor of effective care and treatment of mental illness in primary care and other mainstream settings. DISCUSSION: Predicting the future of health care is speculative, but it may be easier using the Weisbrod formulation to understand the process of mental health reform. Over-reliance on administrative techniques for building static efficiency and false optimism about dynamic efficiency from new technology have stymied previous reforms. All the same, a fifth cycle of reform could succeed, if the right conditions are met and mainstream resources are available.

Community Mental Health Services↗
PubMed2002

Carving out care.

Explore the source record for details and available documents.

Cost-Benefit Analysis↗
PubMed2002

Behavioral health issue brief: minimum mandated benefits and mandated offerings for mental health and substance abuse: year end report-2002.

Benefit mandates require that some service be provided. Mental health and substance abuse treatment mandates are two of the many types of benefit mandates in state law. The debate over mandated benefit legislation typically centers around consumer protection versus cost. Proponents contend that mandates are necessary to ensure adequate health care for consumers. However, opponents generally argue that mandates drive up premiums, which contributes to the growing number of uninsured.

Humans↗
PubMed2003

Behavioral health issue brief: parity and other insurance mandates for the treatment of mental illness and substance abuse: year end report-2003.

Parity and other insurance mandates for the treatment of mental illness and substance abuse continue to be on the agenda of many state legislatures. A broad spectrum of opinions surround what mandates for mental health and substance abuse could and should be. The debate over mandated benefit legislation typically centers around consumer protection versus cost. There are strong opponents, for example, that advocate for nothing less than full parity for mental health and substance abuse treatment. Equally strong are the groups that oppose parity because they believe it will lead to a health care cost increase and, therefore, an increase in the number of uninsured. Both sides continue to make progress as the victories and the defeats unfold on the floors of state legislatures.

Health Benefit Plans, Employee↗
PubMed2003

Behavioral health issue brief: state budget actions that affect public mental health services and systems: year end report-2003.

With ongoing declines in the economy, states have readjusted their FY 2003 budgets throughout the fiscal year, while at the same time negotiating their upcoming FY 2004 and FY 2005 budgets. Because of the current fluidity of state budgets, this issue brief contains snapshots of actions taken at various times throughout FY 2003. It is intended to provide the reader with a general overview of the effects on public mental health systems, of the decline in state economies. The Health Policy Tracking Service (HPTS) will continue to track this issue, and will update this brief at quarterly intervals.

Budgets↗
PubMed2001

Behavioral health benefits for public employees: effect of mental health parity legislation.

With the passage of the Mental Health Parity Act of 1996 (MHPA), Congress took an important first step toward equalizing treatment under medical plans between physical and mental illnesses by requiring parity in annual and lifetime dollar limits between physical and mental illness. But the Act was limited in scope: it did not mandate mental health benefits nor prohibit other common types of differentials between physical and mental illnesses, such as higher cost-sharing or lower limits on outpatient visits or inpatient treatments. Before Congress' action in 1996, a few of the states had adopted some type of parity requirement. Since 1996, state parity activity has accelerated.Recently, the Center for Health Services Research and Policy through a grant from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, examined contracts providing for mental health benefits for state employees in eight states to assess whether legislative attempts to require parity between physical and mental illnesses resulted in noticeable differences in behavioral health benefits for state employees. We concluded that, except in states that have mandated full parity for some or all types of mental illnesses, behavioral health benefits for state employees have not changed significantly as a result of the state parity laws, since they still remain subject to traditional restrictions, such as higher cost-sharing and greater limitations on outpatient visits and inpatient treatment days, than those imposed on physical illnesses. Thus the considerable state activity surrounding mental health parity may have little effect on state employees' access to mental health services, since although state laws required parity in dollar limitations, they generally permitted the continuation of other plan design features that are more restrictive for mental health coverage. However, many of the contracts we examined were multi-year contract and may not have fully reflected recent state activity. Moreover, if Congress renews the Mental Health Parity Act when it expires in September, 2001, and expands the scope of the Act to cover some of these other plan design features, states with more limited parity laws are likely to follow. In that case, perhaps state employees with mental illnesses may see significant change in the future.

Contracts↗