Was federal parity associated with changes in Out-of-network mental health care use and spending?
Was federal parity associated with changes in Out-of-network mental health care use and spending?
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DOI：
10.1186/s12913-017-2261-9
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发表时间：
2017-05-02
影响因子：
2.8
通讯作者：
Barry, Colleen L.
中科院分区：
文献类型：
--
作者：
Busch, Susan H.;Mcginty, Emma E.;Barry, Colleen L.
背景：保罗·威尔斯通和皮特·多梅尼奇精神健康平等和成瘾公平法案的目标是消除行为健康和普通医疗之间在保险覆盖范围上的差异。法律要求网络外的精神健康福利与网络外的医疗/手术福利相同。保险公司担心这一规定将导致网络外相关支出的不可持续增长。我们检验了联邦平价政策的实施是否与网络外精神卫生保健使用和支出的显著增加相关。方法：我们使用自我保险雇主的医疗保险索赔(2007-2012年)进行了中断的时间序列分析。我们考察了使用网络外精神卫生服务的概率的变化，以及在网络外精神卫生服务使用的条件下，2010年与联邦平价实施相关的门诊网络外精神卫生就诊次数和网络外精神卫生总支出的变化。结果：从2007年到2012年，每月接受网络外精神卫生服务的个人比例从18%大幅下降到12%，在平价实施时一次性下降了3个百分点(p<；.01)。在网络外心理健康服务使用者中，按平价计算，每月就诊次数(.12次；p<；.01)和每月总支出(49美元；p<；.01)都有所增加。尽管实施平价时的支出出现了一次性增长，但伴随着支出增长趋势的减弱，在我们的研究结束时，支出回到了最初的预测。结论：尽管当联邦平价实施时，医疗保险行业表达了担忧，但在实施平价后，网络外的精神卫生支出并没有大幅增加。此外，网络外心理健康服务的使用似乎有所收缩，而不是扩大，这表明保险公司可能已经实施了其他政策来限制网络外的使用，例如增加对网络内提供者的访问。
Background: The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is to eliminate differences in insurance coverage between behavioral health and general medical care. The law requires out-of-network mental health benefits be equivalent to out-of-network medical/surgical benefits. Insurers were concerned this provision would lead to unsustainable increases in out-of-network related expenditures. We examined whether federal parity implementation was associated with significant increases in out-of-network mental health care use and spending.Methods: We conducted an interrupted time series analysis using health insurance claims from self-insured employers (2007-2012). We examined changes in the probability of using out-of-network mental health services and, conditional on out-of-network mental health service use, changes in the number of outpatient out-of-network mental health visits and total out-of-network mental health spending associated with the implementation of federal parity in 2010.Results: From 2007 to 2012, the proportion of individuals receiving any out-of-network mental health services each month declined dramatically from 18 to 12%, with a one-time drop of 3 percentage points at parity implementation (p < .01). Among out-of-network mental health service users, there was an increase in the number of visits per month (.12 visits; p < .01) and total spending per month ($49; p < .01) at parity implementation. Although there was a one-time increase in spending at parity implementation, this increase was accompanied by an attenuation of a trend toward increased spending growth, such that spending was back to original predictions by the end of our study period.Conclusions: Despite concerns expressed by the health insurance industry when federal parity was enacted, out-of-network mental health spending did not substantially increase after parity implementation. In addition, use of out-of-network mental health services appears to have contracted rather than expanded, suggesting insurers may have implemented other policies to curb out-of-network use, such as increasing access to in-network providers.