Mental Disorders, Private Insurance, and SSDI Benefits

该项目将具体说明和估计从私人长期残疾(LTD)福利过渡到社会保障残疾保险(SSDI)福利的计量经济学模型，这些福利是由于精神障碍而在LTD工作的员工。使用来自个人LTD索赔的数据，过渡到SSDI福利的可能性将被建模为以下函数：1)个人雇员、雇主和残疾特征；2)LTD政策条款；3)雇主提供的精神健康保险；4)精神健康治疗资源的可用性；5)雇主的残疾管理努力；以及6)SSDI和其他补偿计划可用性的州际差异。有关SSDI成本的数据还将汇总到雇主年度层面的个人索赔，以估计每年每个员工(由LTD保险覆盖)的SSDI成本模型。该项目的数据将涉及约1400名雇主及其500,000名员工，由LTD保险覆盖。将分析1400名雇主中278名的行政数据、索赔数据、公共来源数据和调查数据。计量经济学方法将包括风险(持续时间)回归以及多种风险模型(其中重返工作岗位和过渡到SSDI福利是相互竞争的风险)。雇主一级成本的估计将使用Manning和Mullahy最近提出的建模医疗支出的方法。还将测试几种利用缺失数据进行估计的方法，作为将我们的雇主调查数据与研究中所有1400名雇主的信息相结合的策略。研究中获得的经验估计将提供有关精神健康福利变化以及福利和补偿计划变化对精神障碍受益人的SSDI成本持续快速上升可能产生的影响的信息。将对SSDI的收入和成本、或管理护理/分拆覆盖面的增加、心理健康专科护理地理可获得性的增加以及雇主的残疾管理努力的影响进行估计。

This project will specify and estimate econometric models of transitions from private, long-term disability (LTD) benefits to Social Security Disability insurance (SSDI) benefits by employees who are on LTD as a result of a mental disorder. Using data from individual LTD claims, the probability of transitioning to SSDI benefits will be modeled as function of: 1) individual employee, employer, and disability characteristics; 2) LTD policy provisions; 3) mental health coverage provided by the employer; 4) availability of mental health treatment resources; 5) employers' disability management efforts; and 6) interstate differences in availability of SSDI and other compensation programs. Data on SSDI costs will also be aggregated over individual claims to the employer-year level for estimating models of SSDI costs per employee (covered by LTD insurance) per year. Data for the project will pertain to approximately 1,400 employers and their 500,00 employees covered by LTD insurance. Administrative data, claims data, data from public sources, and survey data on 278 of these 1,400 employers will be analyzed. Econometric methods will include hazard (duration) regressions as well as multiple hazard models (where return to work and transition to SSDI benefits are the competing risks). Estimation of employer-level costs will use the methods for modeling health expenditures recently proposed by Manning and Mullahy. Several approaches for estimation with missing data will also be tested as strategies for combining our employer survey data with information for all 1,400 employers in the study. The empirical estimates obtained in the study will provide information on the possible implications of changes in mental health benefits and changes in benefit and compensation programs for the continuing rapid rise in SSDI costs for beneficiaries with mental disorders. Estimates will be derived of the impacts, on SSDI receipt and costs, or increased managed care/carve-out coverage, of increased geographic availability of mental health specialty care, and of employers' disability management efforts.