Mental health and substance abuse parity: a case study of Ohio's state employee program.
Mental health and substance abuse parity: a case study of Ohio's state employee program.
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心理健康和药物滥用平等：俄亥俄州雇员计划的案例研究。
DOI：
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发表时间：
1998
影响因子：
1.6
通讯作者：
J. McCulloch
中科院分区：
文献类型：
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作者：
R. Sturm;W. Goldman;J. McCulloch
背景：在美国，治疗酒精、药物滥用和心理健康 (ADM) 问题的保险福利比医疗福利要有限得多。为了改变这种状况，去年有 30 多个州正在考虑立法，要求 ADM 和医疗保健享有平等福利（“平等”）。此类拟议立法的成本后果的不确定性仍然是一个主要障碍。目前还没有关于在管理式医疗下实施平等福利的实际经验或对获得医疗服务和利用的影响的信息。研究目的：记录俄亥俄州在管理式护理下对其州雇员计划采用完全平等的 ADM 护理的经验。俄亥俄州提供了一个异常长的时间序列，包含七年的管理行为健康福利，这使我们能够在具有无限 ADM 福利的计划中研究通货膨胀趋势。方法：我们主要通过案例研究来描述该计划的实施情况，并跟踪 1989 年至 1997 年间 ADM 护理的利用率和成本。我们使用联合行为健康中心和俄亥俄州提供的各种行政和索赔数据及报告。对平价和管理式医疗的利用和成本效应的分析是事前分析，并有多年的随访期。结果：从非管理式赔偿护理转向管理式剥离护理后，每 1000 名会员的住院天数下降了 75%，门诊就诊次数下降了 40%，尽管福利同时增加。随后几年，住院天数持续下降，而住院护理和重症门诊护理等中间服务的使用增加。门诊量稳定在每千人500-550人次之间。研究期间没有迹象表明费用开始增加；相反，成本继续下降。当比较 HMO 下的利用率和扩大福利的剥离下的利用率时，会出现一些不同的情况。在这种情况下，福利的扩大导致门诊利用率和中间服务的大幅增加，而住院天数则略有下降。 1996/1997 年的保险付款几乎与 1993 年 HMO 下的估计费用相同。 结论：与总体医疗保健费用方面出现的通货膨胀焦虑相比，管理式医疗可以为 ADM 护理提供长期成本控制，即使患者自付费用减少且承保限额提高。这可能将 ADM 护理与医疗护理区分开来，造成这种差异的原因包括管理技术的状态（ADM 护理更先进）、治疗的复杂性（医疗护理中的技术利用率更高）和人口因素（医疗费用，但不是行为健康费用，随着人口老龄化而增加）。对健康政策的影响：俄亥俄州的经验表明，在管理式医疗下，ADM 护理的同等水平福利是可以承受的。它表明，只要人们愿意接受管理式医疗，那么阻碍 ADM 政策提案的对成本的担忧就是没有根据的。对研究的影响：成本的持续下降引发了人们对护理水平可能不足的担忧。虽然目前对成本过高的担忧主导了平等立法的政策障碍，但研究的下一步是解决护理质量或健康结果问题，这些领域的了解比成本还要少。
BACKGROUND: In the United States, insurance benefits for treating alcohol, drug abuse and mental health (ADM) problems have been much more limited than medical care benefits. To change that situation, more than 30 states were considering legislation that requires equal benefits for ADM and medical care ("parity") in the past year. Uncertainty about the cost consequences of such proposed legislation remains a major stumbling block. There has been no information about the actual experience of implementing parity benefits under managed care or the effects on access to care and utilization. AIMS OF THE STUDY: Document the experience of the State of Ohio with adopting full parity for ADM care for its state employee program under managed care. Ohio provides an unusually long time series with seven years of managed behavioral health benefits, which allows us to study inflationary trends in a plan with unlimited ADM benefits. METHODS: Primarily a case study, we describe the implementation of the program and track utilization, and costs of ADM care from 1989 to 1997. We use a variety of administrative and claims data and reports provided by United Behavioral Health and the state of Ohio. The analysis of the utilization and cost effect of parity and managed care is pre-post, with a multiyear follow-up period. RESULTS: The switch from unmanaged indemnity care to managed carve-out care was followed by a 75% drop in inpatient days and a 40% drop in outpatient visits per 1000 members, despite the simultaneous increase in benefits. The subsequent years saw a continuous decline in inpatient days and an increased use of intermediate services, such as residential care and intensive outpatient care. The number of outpatient visits stabilized in the range of 500-550 visits per 1000. There was no indication that costs started to increase during the study period; instead, costs continued to decline. A somewhat different picture emerges when comparing utilization under HMOs with utilization under a carve-out with expanded benefits. In that case, the expansion of benefits led to a significant jump in outpatient utilization and intermediate services, while there was a small decrease in inpatient days. Insurance payments in 1996/1997 were almost identical to the estimated costs under HMOs in 1993. CONCLUSIONS: In contrast to the emerging inflation anxiety regarding overall health care costs, managed care can provide long-run cost containment for ADM care even when patient copayments are reduced and coverage limits are lifted. This may differentiate ADM care from medical care and reasons for this difference include the state of management techniques (more advanced for ADM care), complexity of treatments (much higher technology utilization in medical care) and demographic factors (medical, but not behavioral health, costs increase as the population ages). IMPLICATIONS FOR HEALTH POLICY: The experience of the state of Ohio demonstrates that parity level benefits for ADM care are affordable under managed care. It suggests that the concerns about costs that have stymied ADM policy proposals are unfounded, as long as one is willing to accept managed care. IMPLICATIONS FOR RESEARCH: The continuing decline in costs raises concerns that levels of care may become insufficient. While concerns about costs being too high dominate the policy hurdle for parity legislation at this moment, the next step in research is to address quality of care or health outcomes, areas about which even less is known than about costs.
剥离计划和 1996 年《心理健康平等法案》中的心理健康和药物滥用福利。
DOI：
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发表时间：
1998
期刊：
Journal of health care finance.
影响因子：
--
作者：
Sturm,R;McCulloch,J
通讯作者：
McCulloch,J
20 世纪 90 年代的心理健康保险：雇主提供的服务是否越来越少？
DOI：
10.1377/hlthaff.17.3.201
发表时间：
1998
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Jensen,GA;Rost,K;Burton,RP;Bulycheva,M
通讯作者：
Bulycheva,M
行为健康剥离的成本和激励措施。
DOI：
10.1377/hlthaff.17.2.53
发表时间：
1998
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Ma,CA;McGuire,TG
通讯作者：
McGuire,TG