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

描述(申请人提供)：2007年1月1日，俄勒冈州实施了其“精神健康和化学依赖平价立法”。俄勒冈州的平价立法在重要方面不同于其他平价扩展。平等法对行为健康的定义是全面的(宽泛地定义精神健康，包括酗酒和滥用药物)，适用于任何拥有商业团体保险的个人，雇主“自我保险”的人除外。这些变化影响到很大一部分俄勒冈州人的覆盖范围，这可能会导致该州行为健康提供者的执业模式发生变化。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不迁移到行为健康保健的分拆、不对行为健康提供者提供预期的费率折扣、以及没有广泛使用强大的管理性保健方法(如看门、封闭提供者小组或事先授权)的情况下实施。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俄勒冈州全面的平价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覆盖面与医疗总成本之间的关系。这项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，但将导致医疗总成本适度增加。这项拟议的研究将澄清，在缺乏强有力的管理性保健的情况下，在多大程度上可以实施全面平等，而不会“破产”。该申请有两个具体目标：具体目标1.评估俄勒冈州平价立法对服务使用和保险成本的影响程度。我们将使用从俄勒冈州6个商业健康计划收集的4年索赔数据的统计分析来估计平价立法对获取、利用、每个参保人的健康计划支出和参保人自付成本的影响。具体目标2.审查俄勒冈州平等立法对精神健康和酗酒及药物滥用障碍福利的提供和管理的影响。具体地说，我们将使用对6个健康计划的关键健康计划人员的半结构化访谈来确定在平价实施下控制成本的健康计划的战略。我们建议研究俄勒冈州2007年的“平等”法律，该法律要求私营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。俄勒冈州的法律在其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性护理的环境中实施方面是独一无二的。我们拟议的研究将提供关于扩大精神健康和药物滥用障碍的覆盖面与总护理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.