Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Psychiatr Serv. 2018 Apr 1;69(4):396-402. doi: 10.1176/appi.ps.201700203. Epub 2018 Jan 16.
The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation.
A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care.
In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014.
Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.
2008 年《精神健康和平等法案》（MHPAEA）旨在通过规范健康计划对服务的覆盖和管理，来改善获得行为健康护理的机会。健康计划在实现 MHPAEA 合规方面具有一定的酌处权，这使得人们对其对健康计划政策可能产生的影响产生了疑问。在这项研究中，作者的目的是确定在联邦平等法全面实施后，私人健康计划对行为健康治疗的覆盖范围和管理方式发生了怎样的变化。
在美国大陆的 60 个市场地区进行了一项针对商业健康计划的全国代表性调查，2010 年（加权 N=8431）和 2014 年（加权 N=6974）的回应率分别为 89%和 80%。在每一年，对做出回应的计划的高管进行了有关行为健康服务的访谈，并（在 2014 年）询问了有关变化的情况。使用学生 t 检验来检验行为健康和一般医疗保健所涵盖的服务、自付费用和事先授权要求的变化。
2014 年，68%的保险产品报告称自 2010 年以来扩大了行为健康覆盖范围。在 2010 年（23%）和 2014 年（0%）之间，取消了饮食失调治疗的排除范围。然而，在 2014 年，更多的产品报告称排除了自闭症治疗（24%）而不是 2010 年（8%）。大多数计划报告称 2010 年至 2014 年期间，事先授权要求没有变化。
联邦平等立法的实施似乎伴随着行为健康覆盖范围的持续改善。作者没有发现广泛的不合规或意外影响的证据，例如完全取消行为健康护理的覆盖范围。
