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

俄勒冈州平等法：当今医疗环境中的全面平等

• 批准号: 7501317
• 负责人: Kenneth John McConnell
• 金额: $ 31.89万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-28 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7501317
• 关键词: Affect; Alcohols; Caring; Chemicals; Collection; Cost Control; Data; Dependency; Disease; Drug Abuse Treatment Services; Drug abuse; Effectiveness; Environment; Gatekeeping; Goals; Health; Health Care Costs; Health Personnel; Health Planning; Health Services; Healthcare; Human Resources; Individual; Insurance; Insurance Carriers; Interview; Laws; Lead; Managed Care; Marketing; Medical; Mental Health; Mental disorders; Methods; Oregon; Patients; Pattern; Pharmaceutical Preparations; Provider; Rate; Research; Services; Statutes and Laws; Structure; Substance abuse problem; Today; base; behavioral health; cost; discount; experience; improved; insight; migration; novel; parity; prior authorization; service utilization; tool; trend

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.

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平等立法"。“俄勒冈州的平价立法在重要方面不同于其他平价扩张。平等法对行为健康的定义是全面的（广义上定义了精神健康，包括酗酒和吸毒），适用于任何拥有商业团体保险的个人，但雇主自行保险的人除外。“这些变化影响了很大一部分俄勒冈人的覆盖面，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，与以前关于平等的研究形成鲜明对比的是，俄勒冈州的法律将在没有迁移到行为医疗保健的分割的情况下实施，没有预期的行为医疗保健提供者的费率折扣，也没有广泛使用强有力的管理式医疗方法，如守门，封闭式提供者小组或事先授权。该应用程序的总体目标是使用6个商业健康计划的数据来检查全面的俄勒冈州均等立法对获取和成本的影响，这些计划占俄勒冈州商业市场的70%以上。我们的长期目标是了解扩大行为健康服务的覆盖范围与总医疗保健费用之间的关系。拟议研究背后的具体假设是，俄勒冈州的平价立法将改善患者获得行为医疗保健的机会，但将导致护理总成本适度增加。拟议的研究将澄清在没有强有力的管理式保健的情况下，在多大程度上可以在不“破产"的情况下实现全面均等。“该申请有两个具体目标：具体目标1。评估俄勒冈州平等立法对服务使用和覆盖成本的影响程度。我们将使用从俄勒冈州的6个商业健康计划收集的4年索赔数据的统计分析，以估计均等立法对获得，利用，每个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。检查俄勒冈州的平等立法对精神健康和酒精和药物滥用障碍的福利的提供和管理的影响。具体而言，我们将使用6个健康计划的关键健康计划人员的半结构化访谈，以确定健康计划的战略，以控制平价实施下的成本。麦康奈尔，KJ我们建议研究俄勒冈州2007年的“平等”法，该法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一般医疗保健相同的福利。俄勒冈州的法律是独一无二的，因为它对精神健康和药物滥用有着全面的定义，而且在没有强有力的管理护理的环境中实施。我们提出的研究将提供有关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权衡的见解。