Oregon's Parity Law: Comprehensive Parity in Today's Healthcare Environment

描述（由申请人提供）：2007年1月1日，俄勒冈州实施了“精神健康和化学品依赖均等立法”。俄勒冈州的平等立法在许多重要方面不同于其他的平等扩张。平等法对行为健康的定义是全面的（广义地定义了精神健康，包括酗酒和吸毒），适用于任何拥有商业团体保险的个人，但雇主“自保”的人除外。这些变化影响了很大一部分俄勒冈人的覆盖范围，这可能导致该州行为健康提供者的实践模式发生变化。也许最重要的是，与之前关于平价的研究形成鲜明对比的是，俄勒冈州的法律将在没有向行为健康保健的分割转移的情况下实施，没有对行为健康提供者的预期折扣，也没有广泛使用强有力的管理护理方法，如把关、封闭的提供者小组或事先授权。本应用程序的总体目标是使用6个商业健康计划（占俄勒冈商业市场的70%以上）的数据，检查全面的俄勒冈平价立法对获取和成本的影响。我们的长期目标是了解行为健康服务覆盖面的扩大与医疗保健总成本之间的关系。提出的研究背后的具体假设是，俄勒冈州的平等立法将改善患者获得行为健康护理的机会，但会导致护理总成本的适度增加。拟议的研究将阐明，在缺乏强有力的管理式医疗的情况下，在不“倾家荡产”的情况下，实现全面平等的程度。该应用程序有两个具体目标：评估俄勒冈州平价立法对服务使用和覆盖成本的影响程度。我们将对从俄勒冈州6个商业健康计划中收集的4年索赔数据进行统计分析，以估计平价立法对获取、利用、每位参保人的健康计划支出和参保人自付费用的影响。具体目标2。审查俄勒冈州平等立法对提供和管理精神健康、酗酒和吸毒障碍福利的影响。具体而言，我们将对6个健康计划的关键健康计划人员进行半结构化访谈，以确定健康计划在平价实施下控制成本的策略。我们建议研究俄勒冈州2007年的“平等”法律，该法律规定私人健康保险公司为精神健康和药物滥用治疗提供与普通医疗保健同等的福利。俄勒冈州的法律在对精神健康和药物滥用的全面定义以及在没有强有力的管理护理的环境中实施方面是独一无二的。我们提出的研究将提供关于扩大精神健康和药物滥用障碍的覆盖范围与护理总成本之间的权衡的见解。

DESCRIPTION (provided by applicant): On January 1, 2007, Oregon implemented its "Mental Health and Chemical Dependency Parity Legislation." Oregon's parity legislation differs in important ways from other parity expansions. The parity law is comprehensive in its definition of behavioral health (broadly defining mental health and including alcohol and drug abuse), and applies to any individual with commercial group insurance, except for those whose employers "self-insure." The changes affect coverage for a large proportion of Oregonians, which may lead to changes in practice patterns among the state's behavioral health providers. Perhaps most importantly, and in sharp contrast to previous research on parity, Oregon's law will be implemented without a migration to carve-outs for behavioral health care, without anticipated rate discounts for behavioral health providers, and without extensive use of strong managed care methods, such as gatekeeping, closed provider panels, or prior authorization. The overall goals of this application are to examine the effects of the comprehensive Oregon parity legislation on access and cost, using data from 6 commercial health plans, which comprise more than 70% of Oregon's commercial market. Our long term goal is to understand the relationship between expanding coverage of behavioral health services and total health care costs. The specific hypothesis behind the proposed research is that Oregon's parity legislation will improve patients' access to behavioral health care, but will lead to moderate increases in the total cost of care. The proposed research will clarify the extent to which comprehensive parity, in the absence of strong managed care, can be implemented without "breaking the bank." The application has two specific aims: Specific Aim 1. Assess the degree to which the Oregon parity legislation affects the use of services and cost of coverage. We will use statistical analyses of 4 years of claims data collected from 6 commercial health plans in Oregon to estimate the effect of the parity legislation on access, utilization, health plan spending per enrollee, and enrollee out-of pocket cost. Specific Aim 2. Examine the effect of Oregon's parity legislation on the provision and management of benefits for mental health and alcohol and drug abuse disorders. Specifically, we will use semi-structured interviews of key health plan personnel at 6 health plans to identify health plans' strategies for containing costs under the parity implementation. McConnell, KJ We propose to study Oregon's 2007 "parity" law, which mandates that private health insurers provide benefits for mental health and substance abuse treatment that are equal to the benefits for general medical care. Oregon's law is unique in its comprehensive definition of mental health and substance abuse and in its implementation in an environment without strong managed care. Our proposed research will provide insight about the tradeoffs between expanding coverage for mental health and substance abuse disorders and the total cost of care.