Peck Marcia C, Scheffler Richard M
Department of Medicine, Stanford University Hospital, California 94305, USA.
Psychiatr Serv. 2002 Sep;53(9):1089-95. doi: 10.1176/appi.ps.53.9.1089.
Thirty-four states have enacte mental health parity laws that require a health plan, insurer, or employer to provide coverage for mental illness equal to that for physical illness. This study analyzed definitions of mental illness used in state parity laws, identified factors influencing the development of these definitions, and examined the effects of different definitions on access to care for persons with mental illness.
Specific language in each state's parity legislation was analyzed. Interviews were conducted with policy makers, mental health providers, advocates, and insurers to determine factors influencing a state's definition. Current definitions of mental illness used in the clinical literature and in federal policy were reviewed and compared with definitions used in state parity laws.
The definitions of mental illness used in state parity legislation vary significantly and fall into one of three major categories: "broad-based mental illness," "serious mental illness," or "biologically based mental illness." To define each of these categories, state legislatures do not rely on clinically accepted definitions or federal mental health policy. Rather, influenced by political and economic factors, they are developing their own definitions.
Definitions of mental illness in state parity laws have important implications for access, cost, and reimbursement; they determine which populations receive a higher level of mental health services. Future research must qualitatively examine how state definitions affect the use and cost of mental health services.
34个州已颁布心理健康平权法，要求健康计划、保险公司或雇主为精神疾病提供与身体疾病同等的保险覆盖范围。本研究分析了州平权法中使用的精神疾病定义，确定了影响这些定义制定的因素，并研究了不同定义对精神疾病患者获得护理的影响。
分析了每个州平权立法中的具体措辞。与政策制定者、心理健康服务提供者、倡导者和保险公司进行了访谈，以确定影响一个州定义的因素。回顾了临床文献和联邦政策中目前使用的精神疾病定义，并与州平权法中使用的定义进行了比较。
州平权立法中使用的精神疾病定义差异很大，可分为三大类之一：“广泛的精神疾病”、“严重精神疾病”或“基于生物学的精神疾病”。为定义这些类别中的每一类，州立法机构并不依赖临床认可的定义或联邦心理健康政策。相反，受政治和经济因素影响，他们正在制定自己的定义。
州平权法中的精神疾病定义对获得护理、成本和报销有重要影响；它们决定了哪些人群能获得更高水平的心理健康服务。未来的研究必须定性地研究州定义如何影响心理健康服务的使用和成本。
