Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI.
Stanford Law School and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
Med Care. 2019 Apr;57(4):245-255. doi: 10.1097/MLR.0000000000001076.
Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act.
To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers.
Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group.
Commercially insured enrollees aged 18-64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1-2 years postpolicy.
Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations.
Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, respectively. Corresponding annual mental health visits increased by 0.31 (0.12, 0.51) and 0.59 (0.37, 0.81) per enrollee. Difference-in-difference changes were larger for the highest baseline quartile mental health care utilizers [year 2: 0.76 visits per enrollee (0.14, 1.38); relative increase 10.07%] and spenders [year 2: $-2.28 (-3.76, -0.79); relative reduction 5.91%]. There were no significant difference-in-differences changes in emergency department visits or hospitalizations.
In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity.
数十年来，人们一直致力于要求行为健康保险和身体医疗保险覆盖范围保持一致，最终促成了全面的联邦精神健康平等待遇和成瘾权益法案。
确定联邦平等待遇与精神保健服务利用和支出变化之间的关联，特别是在高利用率人群中的关联。
采用双重差分分析比较了暴露于联邦平等待遇前后与对照组之间的变化。
从 24 个州抽取的 18-64 岁患有精神障碍的商业保险参保者，这些州的私营雇主在 2010 年首次受到联邦平等待遇的约束（暴露组），但小型雇主在平等待遇前后均不受约束（对照组）。对 11226 名暴露组成员进行倾向评分匹配（1:1）与对照组成员相匹配，所有成员在政策前一年到政策后 1-2 年期间均连续参保。
精神科门诊就诊次数、这些就诊的自付费用、急诊就诊次数和住院治疗次数。
与对照组成员相比，暴露组参保者每次门诊精神科就诊的自付费用在政策后的第 1 年和第 2 年分别下降了 0.74 美元（1.40 美元，0.07 美元）和 2.03 美元（3.17 美元，0.89 美元）。相应的每年精神科就诊次数每人分别增加了 0.31 次（0.12 次，0.51 次）和 0.59 次（0.37 次，0.81 次）。对于基线 quartile 中精神保健利用率最高的人群，差异变化更大[第 2 年：每人就诊 0.76 次（0.14 次，1.38 次）；相对增加 10.07%]和支出者[第 2 年：-2.28 美元（-3.76 美元，-0.79 美元）；相对减少 5.91%]。急诊就诊或住院治疗没有显著的差异变化。
在 24 个州，商业保险的精神保健服务高利用率者在平等待遇后 2 年经历了门诊精神保健就诊次数的适度增加。
