Hodgkin Dominic, Horgan Constance M, Garnick Deborah W, Merrick Elizabeth L
Brandeis University, USA.
Med Care Res Rev. 2003 Mar;60(1):101-16. doi: 10.1177/1077558702250248.
Recent initiatives to improve private insurance coverage for substance abuse and mental health in the United States have mostly focused on equalizing coverage limits to those found in general medical care. Federal law does not address cost sharing (copayments and coinsurance), which may also deter needed care or impose significant financial burdens on enrollees. This article reports on cost sharing requirements for outpatient care in a nationally representative sample of managed care plans in 1999. Levels of cost sharing are substantial, with around 40 percent of products requiring copayments of $20 or more and another 15 percent requiring coinsurance of 50 percent. Cost sharing for outpatient substance abuse treatment is very similar to that for mental health. Compared to general medical care, at least 30 percent of products impose higher cost sharing for substance abuse and mental health treatment. Future parity initiatives should be examined for how they address differences in cost sharing as well as limits.
美国近期旨在改善药物滥用和心理健康方面私人保险覆盖范围的举措，大多聚焦于使覆盖范围限制与一般医疗保健中的限制相等。联邦法律未涉及费用分担（共付额和 coinsurance），这也可能阻碍必要的治疗，或给参保人带来巨大经济负担。本文报告了1999年全国代表性的管理式医疗计划样本中门诊治疗的费用分担要求。费用分担水平很高，约40%的产品要求共付额为20美元或更多，另有15%要求 coinsurance 为50%。门诊药物滥用治疗的费用分担与心理健康治疗非常相似。与一般医疗保健相比，至少30%的产品对药物滥用和心理健康治疗施加了更高的费用分担。未来的平等举措应审视其如何处理费用分担以及覆盖范围限制方面的差异。
