Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services

Medical Care
Rebecca L HaffajeeJ Frank Wharam

Abstract

Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act. To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers. Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group. Commercially insured enrollees aged 18-64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1-2 years postpolicy. Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations. Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, ...Continue Reading

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