联邦雇员的行为健康保险平价。

Behavioral health insurance parity for federal employees.

作者信息

Goldman Howard H, Frank Richard G, Burnam M Audrey, Huskamp Haiden A, Ridgely M Susan, Normand Sharon-Lise T, Young Alexander S, Barry Colleen L, Azzone Vanessa, Busch Alisa B, Azrin Susan T, Moran Garrett, Lichtenstein Carolyn, Blasinsky Margaret

机构信息

University of Maryland School of Medicine, Baltimore, MD 21227, USA.

出版信息

N Engl J Med. 2006 Mar 30;354(13):1378-86. doi: 10.1056/NEJMsa053737.

DOI:10.1056/NEJMsa053737

PMID:16571881

Abstract

BACKGROUND

To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits (FEHB) Program offered mental health and substance-abuse benefits on a par with general medical benefits beginning in January 2001. The plans were encouraged to manage care.

METHODS

We compared seven FEHB plans from 1999 through 2002 with a matched set of health plans that did not have benefits on a par with mental health and substance-abuse benefits (parity of mental health and substance-abuse benefits). Using a difference-in-differences analysis, we compared the claims patterns of matched pairs of FEHB and control plans by examining the rate of use, total spending, and out-of-pocket spending among users of mental health and substance-abuse services.

RESULTS

The difference-in-differences analysis indicated that the observed increase in the rate of use of mental health and substance-abuse services after the implementation of the parity policy was due almost entirely to a general trend in increased use that was observed in comparison health plans as well as FEHB plans. The implementation of parity was associated with a statistically significant increase in use in one plan (+0.78 percent, P<0.05) a significant decrease in use in one plan (-0.96 percent, P<0.05), and no significant difference in use in the other five plans (range, -0.38 percent to +0.23 percent; P>0.05 for each comparison). For beneficiaries who used mental health and substance-abuse services, spending attributable to the implementation of parity decreased significantly for three plans (range, -201.99 dollars to -68.97 dollars; P<0.05 for each comparison) and did not change significantly for four plans (range, -42.13 dollars to +27.11 dollars; P>0.05 for each comparison). The implementation of parity was associated with significant reductions in out-of-pocket spending in five of seven plans.

CONCLUSIONS

When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.

摘要

背景

为提高心理健康和药物滥用服务的保险覆盖范围，联邦雇员健康福利（FEHB）计划自2001年1月起提供与一般医疗福利相当的心理健康和药物滥用福利。这些计划被鼓励进行医疗管理。

方法

我们将1999年至2002年的7个FEHB计划与一组匹配的健康计划进行比较，这些健康计划没有与心理健康和药物滥用福利相当的福利（心理健康和药物滥用福利平价）。使用差异分析，我们通过检查心理健康和药物滥用服务使用者的使用率、总支出和自付费用，比较了FEHB计划和对照计划匹配对的索赔模式。

结果

差异分析表明，平价政策实施后心理健康和药物滥用服务使用率的观察到的增加几乎完全归因于在对照健康计划以及FEHB计划中观察到的使用增加的总体趋势。平价的实施与一个计划中的使用量有统计学意义的增加（+0.78%，P<0.05）、一个计划中的使用量显著减少（-0.96%，P<0.05）以及其他五个计划中的使用量无显著差异（范围为-0.38%至+0.23%；每次比较P>0.05）相关。对于使用心理健康和药物滥用服务的受益人，三个计划中因平价实施而产生的支出显著减少（范围为-201.99美元至-68.97美元；每次比较P<0.05），四个计划中没有显著变化（范围为-42.13美元至+27.11美元；每次比较P>0.05）。平价的实施与七个计划中的五个计划的自付费用显著减少相关。