Parity, child mental health, and substance abuse

平等、儿童心理健康和药物滥用

• 批准号: 7894919
• 负责人: ELLEN R. MEARA
• 金额: $ 57.79万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2012-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7894919
• 关键词: Accounting; Address; Adolescent; Affect; Age; Alcohol or Other Drugs use; Alcohols; Amendment; Annual Reports; Applications Grants; Behavioral; Benchmarking; Binomial Model; Child; Child Behavior Checklist; Child Mental Health; Clinical; Coinsurance; Collection; Consent; Contracts; Data; Data Collection; Data Set; Data Sources; Deductibles and Coinsurance; Dependence; Economics; Elements; Employee Health; Enrollment; Environment; Evaluation; Face; Family; Fee-for-Service Plans; Funding; Health; Health Benefit; Health Insurance; Health Planning; Health Policy; Health Services; Healthcare; Healthcare Systems; Illicit Drugs; Income; Individual; Inpatients; Insurance; Insurance Benefits; Insurance Coverage; Laws; Lead; Learning; Left; Life; Linear Models; Low income; Marijuana; Medicaid; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Natural experiment; Nature; Online Systems; Operative Surgical Procedures; Outcome; Outpatients; Parents; Pharmaceutical Preparations; Policies; Policy Maker; Population; Problem behavior; Process; Public Health; Qualifying; Recording of previous events; Reporting; Research; Research Methodology; Services; Severities; State Children' s Health Insurance Program; Statutes and Laws; Substance Use Disorder; Substance abuse problem; Surveys; Symptoms; Teenagers; Time; Tobacco use; Uninsured; United States Centers for Medicare and Medicaid Services; Variant; Visit; Vulnerable Populations; addiction; aged; base; behavioral health; cost; design; experience; follow-up; health care service organization; improved; indexing; informant; meetings; organizational structure; parity; payment; policy implication; prevent; programs; response; social; surgical service

The recent passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires private health plans to provide equal coverage of behavioral and medical/surgical services, also known as parity, represents an important step in the expansion of access to substance abuse and mental health treatment. The new law will create an opportunity for new funding for behavioral health services, and it will likely launch a significant restructuring of private and public insurance coverage for behavioral health treatments. In fact, the new legislation may have its largest public health impact through its indirect influence on the State Children’s Health Insurance Program (SCHIP), public health insurance coverage for children under 20 not income-eligible for Medicaid. SCHIP enrollees suffer behavioral health problems at higher rates than in the overall child population, like their counterparts on Medicaid. However, SCHIP programs tend to limit coverage of behavioral health treatment through visit/day limits, high co-payments, coinsurance, and deductibles in ways that Medicaid programs do not. Federal parity legislation is especially significant for many SCHIP programs because these states meet federal SCHIP benefit requirements by benchmarking behavioral health benefits against private insurance plans directly affected by the new law. Thus, the new legislation creates a natural experiment by effectively inducing changes in benefit design, and likely changes in the management of behavioral health services in some SCHIP programs, while leaving other programs that do not benchmark benefits in this way unchanged. The effect of this legislation on access to substance abuse and mental health services was further strengthened by the reauthorization of SCHIP in February of 2009, both because it expands the scope of the program with additional funding, and because it requires parity. We propose to exploit the variation created by new federal parity legislation to pursue three aims. 1) to examine how SCHIP programs change behavioral health benefit design and management approaches in response to changes in benchmark plans induced by parity legislation; and 2) to estimate changes in SCHIP coverage, utilization and out of pocket spending for child behavioral health services (Aim 2) among likely SCHIP enrollees in affected states following the implementation of new federal parity legislation. We will pursue these aims with primary data collection regarding benefit design and management features of state SCHIP programs before and after the law change (Aim 1). Second, we will survey parents regarding substance abuse and mental health service use and related outcomes among children aged 3 to 17 before the law change takes effect and 12 months after the law change (Aim 2). We will analyze these new data using appropriate panel data methods to account for repeated observations on individuals, and using estimation strategies such as generalized Poisson or negative binomial models for count data and generalized linear models to address spending data, which are often highly skewed.

最近通过的2008年《保罗·韦尔斯通和皮特·多梅尼奇精神健康平等和成瘾平等法》要求私人健康计划提供平等的行为和医疗/手术服务，也称为平等，这是扩大获得药物滥用和精神健康治疗的重要一步。新法律将为行为健康服务提供新的资金，并可能对行为健康治疗的私人和公共保险范围进行重大重组。事实上，新的立法可能通过其对国家儿童健康保险计划（SCHIP）的间接影响产生最大的公共卫生影响，SCHIP是20岁以下儿童的公共健康保险，不符合医疗补助的收入条件。SCHIP注册者遭受行为健康问题的比率高于整体儿童人口，就像他们在医疗补助计划中的同行一样。然而，SCHIP计划倾向于通过访问/日限制，高共同支付，共同保险和医疗补助计划没有的方式来限制行为健康治疗的覆盖范围。联邦平等立法对许多SCHIP计划尤其重要，因为这些州通过将行为健康福利与直接受新法律影响的私人保险计划进行基准比较，满足了联邦SCHIP福利要求。因此，新的立法创造了一个自然的实验，有效地诱导福利设计的变化，并可能改变一些SCHIP计划中的行为健康服务的管理，同时让其他计划不以这种方式基准福利不变。2009年2月，SCHIP重新获得授权，进一步加强了这项立法对获得药物滥用和精神健康服务的影响，这既是因为它扩大了方案的范围，增加了资金，也是因为它要求平等。我们建议利用新的联邦平等立法所创造的变化来追求三个目标。1)研究SCHIP计划如何改变行为健康福利设计和管理方法，以应对均等立法引起的基准计划的变化; 2）估计新的联邦均等立法实施后，受影响州可能的SCHIP登记者中SCHIP覆盖率、利用率和儿童行为健康服务自付支出（目标2）的变化。我们将追求这些目标与主要数据收集有关的利益设计和管理功能的国家SCHIP计划之前和之后的法律变化（目标1）。第二，我们将在法律修改生效前和法律修改后12个月（目标2）对3至17岁儿童的药物滥用和精神卫生服务使用情况及其相关结果进行调查。我们将使用适当的面板数据方法来分析这些新数据，以考虑对个人的重复观察，并使用估计策略，例如用于计数数据的广义泊松或负二项模型以及用于解决支出数据的广义线性模型，这些数据通常高度倾斜。