Mental Health Coverage in Health Care Reform

医疗改革中的心理健康覆盖

• 批准号: 8274646
• 负责人: Thomas G. McGuire
• 金额: $ 46.69万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2014-05-08
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8274646
• 关键词: Address; Caring; Chronic; Chronic Disease; Cost Sharing; Data; Dimensions; Economics; Expenditure; Face; Family; Federal Government; France; Goals; Health Care Reform; Health Insurance; Health Planning; Health Status; Healthcare; Improve Access; Incentives; Income; Individual; Insurance; Left; Legal; Low income; Mainstreaming; Managed Competition; Marketing; Massachusetts; Measures; Medicaid; Medical; Mental Health; Mental disorders; Methodology; Methods; Modeling; Modification; Online Systems; Participant; Patients; Pattern; Persons; Policies; Population; Poverty; Price; Psyche structure; Regulation; Research; Risk Adjustment; Running; Slide; Structure; Surveys; Testing; Uninsured; United States National Institutes of Health; Update; authority; base; design; evidence base; indexing; innovation; meetings; parity; risk selection; risk sharing; sound

DESCRIPTION (provided by applicant): An innovative and potentially far-reaching component of The Patient Protection and Affordable Care Act (ACA) is creation of new state-level health insurance markets referred to as "Exchanges." As of January 1, 2014, U.S. citizens and legal residents who are not eligible for employer-sponsored or public coverage will be able to purchase health insurance through new Exchanges, consolidating and regulating the market for individual insurance. Plans offered through the Exchanges will cover a federally defined "essential benefit package," which includes parity in coverage for mental health care. Premium and cost-sharing subsidies will apply on a sliding scale for individuals and families earning up to 400% of poverty. Extension of Exchange-based insurance to an estimated 24 million people promises to improve access to mental health care, provide financial protection, and integrate low-income groups into the mainstream of health care. A central lesson of economics and mental health in the past 30 years, however, is that competition and choice in private health insurance markets does not meet the needs of persons with mental illness (and other chronic conditions). The danger is: to avoid drawing an "adverse selection" of risks in a private health insurance market, Exchange plans may systematically under provide care for mental and other chronic illnesses. This project proposes to conduct fundamental economic research on the patterns of health care use by persons with mental illness in order to establish the evidence base for sound choices about structuring health insurance markets in the Exchanges. We plan to assess the magnitude of the selection problem among likely Exchange participants, and based on this, identify and evaluate options for correcting incentives to health plans to provide efficient and fair coverage for person with mental illness. In summary, we intend to: 1) Measure the strength of incentives for adverse selection among populations likely to participate in Exchanges using multiple years of nationally representative data from the Medical Expenditure Panel Survey (MEPS), and test whether selection-driven incentives are greater for mental health than other conditions. We will examine selection incentives at the individual and family level. 2) Evaluate the consequences for selection incentives of design choices in health insurance Exchanges, including: risk adjustment, risk-sharing, stop-losses, carve-outs, and limited choice of plans. Compare alternatives quantitatively within a unified theoretical and empirical framework. The goal is to guide policy so as to avoid pitfalls of the past in mental health and individual private health insurance markets. This proposal responds to Frances Collins' call to devote NIH research effort to benefit health care reform.

描述（由申请人提供）：《患者保护和平价医疗法案》(ACA) 的一个创新且可能影响深远的组成部分是创建新的州级健康保险市场，称为“交易所”。自 2014 年 1 月 1 日起，不符合雇主赞助或公共保险资格的美国公民和合法居民将能够通过新的交易所购买健康保险，从而巩固和规范个人保险市场。通过交易所提供的计划将涵盖联邦政府定义的“基本福利计划”，其中包括平等的精神卫生保健覆盖范围。保费和费用分摊补贴将以浮动比例适用于收入不超过贫困率 400% 的个人和家庭。将基于交易所的保险扩展到估计 2400 万人，有望改善获得精神卫生保健的机会，提供财务保护，并将低收入群体纳入医疗保健主流。然而，过去 30 年经济和心理健康的一个中心教训是，私人健康保险市场的竞争和选择不能满足精神疾病（和其他慢性病）患者的需求。危险在于：为了避免在私人健康保险市场中出现“逆向选择”风险，交换计划可​​能会系统性地减少对精神疾病和其他慢性疾病的护理。 该项目提议对精神疾病患者的医疗保健使用模式进行基础经济研究，以便为在交易所构建健康保险市场的合理选择奠定证据基础。我们计划评估可能的交易所参与者中选择问题的严重程度，并在此基础上确定和评估纠正健康计划激励措施的选项，以便为精神疾病患者提供有效和公平的保险。总之，我们打算：1）使用医疗支出面板调查（MEPS）的多年全国代表性数据来衡量可能参与交易所的人群中逆向选择的激励强度，并测试选择驱动的激励是否比其他条件更能促进心理健康。我们将审查个人和家庭层面的选择激励措施。 2）评估健康保险交易所设计选择的选择激励的后果，包括：风险调整、风险分担、止损、剥离和有限的计划选择。在统一的理论和实证框架内定量比较替代方案。 目标是指导政策，以避免心理健康和个人私人健康保险市场陷入过去的陷阱。该提案响应了弗朗西斯·柯林斯 (Frances Collins) 的号召，即将 NIH 的研究工作投入到医疗改革中。