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Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services.

Publication ,  Journal Article
Haffajee, RL; Mello, MM; Zhang, F; Busch, AB; Zaslavsky, AM; Wharam, JF
Published in: Med Care
April 2019

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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Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

April 2019

Volume

57

Issue

4

Start / End Page

245 / 255

Location

United States

Related Subject Headings

  • Patient Acceptance of Health Care
  • Mental Health Services
  • Mental Disorders
  • Male
  • Insurance, Health
  • Insurance Coverage
  • Humans
  • Health Policy & Services
  • Health Expenditures
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Haffajee, R. L., Mello, M. M., Zhang, F., Busch, A. B., Zaslavsky, A. M., & Wharam, J. F. (2019). Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services. Med Care, 57(4), 245–255. https://doi.org/10.1097/MLR.0000000000001076
Haffajee, Rebecca L., Michelle M. Mello, Fang Zhang, Alisa B. Busch, Alan M. Zaslavsky, and J Frank Wharam. “Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services.Med Care 57, no. 4 (April 2019): 245–55. https://doi.org/10.1097/MLR.0000000000001076.
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 Apr;57(4):245–55.
Haffajee, Rebecca L., et al. “Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services.Med Care, vol. 57, no. 4, Apr. 2019, pp. 245–55. Pubmed, doi:10.1097/MLR.0000000000001076.
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 Apr;57(4):245–255.

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

April 2019

Volume

57

Issue

4

Start / End Page

245 / 255

Location

United States

Related Subject Headings

  • Patient Acceptance of Health Care
  • Mental Health Services
  • Mental Disorders
  • Male
  • Insurance, Health
  • Insurance Coverage
  • Humans
  • Health Policy & Services
  • Health Expenditures
  • Female