Sturm R, Zhang W, Schoenbaum M
RAND, Santa Monica, CA 90401, USA.
J Behav Health Serv Res. 1999 May;26(2):203-10. doi: 10.1007/BF02287491.
Substance abuse (SA) care has been excluded from recent federal and state legislation mandating equal benefits for mental health and medical care ("parity"), largely because of cost concerns. This article studies how many patients are affected by SA coverage limits and the likely implications of limits on insurance payments, using 1996-97 claims from 25 managed care plans with unlimited SA benefits. Changing even stringent limits on annual SA benefits has a small absolute effect on overall insurance costs under managed care, even though a large percentage of SA patients are affected. Removing an annual limit of $10,000 per year on SA care is estimated to increase insurance payments by about 6 cents per member per year, removing a limit of $1,000 increases payments by about $3.40. As long as care is comprehensively managed, "parity" for SA in employer-sponsored health plans is not very costly.
药物滥用（SA）护理被排除在近期要求心理健康和医疗护理享有平等福利（“平价”）的联邦和州立法之外，主要是出于成本考虑。本文利用25个提供无限制SA福利的管理式医疗计划1996 - 1997年的理赔数据，研究了多少患者受到SA保险覆盖范围限制的影响以及这些限制对保险赔付可能产生的影响。即使是对年度SA福利设置非常严格的限制，对管理式医疗下的总体保险成本的绝对影响也很小，尽管很大比例的SA患者会受到影响。估计取消每年10,000美元的SA护理年度限额，每年每位参保人的保险赔付将增加约6美分，取消1,阗美元的限额则赔付增加约3.40美元。只要护理得到全面管理，雇主赞助的健康计划中SA的“平价”成本并不高。
