|
Study focuses
on mental health parity legislation
(June
2006 Issue)
By Phyllis Hanlon
A group of researchers recently conducted a study in which they
focused on the utilization and spending on mental health services
before and after federal parity legislation was enacted. Their findings
provide a strong argument for advocates of mental health parity
legislation.
For years, care for those suffering mental health issues had been
thought of as long-term custody and responsibility of the state
and policymakers doubted that the federal government could provide
efficient coverage, according to Howard H. Goldman, M.D., MPH, Ph.D.,
professor of psychiatry at the University of Maryland School of
Medicine.
He says that states had passed a number of parity statutes since
1971, but all came with conditions. In 1999, President Clinton mandated
the Office of Personnel Management (OPM) to offer parity to federal
employees. The resulting Federal Employees Health Benefits Program
(FEHB) provided comparable coverage for mental health and substance
abuse issues as that proffered for physical health diagnoses. Parity
for federal employees was implemented on Jan. 1, 2001.
Goldman and Richard G. Frank, Ph.D., professor of health economics
at Harvard Medical School, together with a parity evaluation research
team, published findings of their study in the March 30 issue of
the New England Journal of Medicine. Goldman and Frank compared
seven federal health insurance plans from 1999 to 2002 with equivalent
private plans that did not provide parity benefits. More than 300,000
individuals were enrolled in the plans during the study period,
adding credibility to the results.
This research team examined the number of annual visits because
of mental health issues; the total spending on mental health and
substance abuse services including psychiatric visits, inpatient
stays, primary care physician and nursing care and drugs and out-of-pocket
spending on mental health and substance abuse services.
According to their observations, no significant differences in
total cost and usage of mental health and substance abuse services
in either the federal or private plans were associated with the
parity policy. Additionally, they point out that subscribers of
five of the seven federal plans experienced an average $14 to $87
annual reduction in out-of-pocket spending.
Goldman notes that all plans fall under managed care, which he
says accounts for the effectiveness of the parity policy. "Managed
care helps redirect a fairly stable demand. They [managed care]
have figured out how to prioritize within their budgets. They don't
use aggressive treatment strategies," he says. "The results suggest
that if you are doing parity and are concerned about the cost, do
it with managed care."
Frank admits that premiums could increase if the responsibility
for final payment is changed from the individual to the health plan.
However, he predicts an increase of less than .5 percent. He says
that projections as a result of the study are likely to generalize
to other employer benefits. "The biggest benefits of parity include
the removal of social stigma, acceptance and accessibility to mental
health care, which, in turn, increases physical health," says Goldman.
The study authors suggest that parity provides insurance protection
while still delivering quality care at a reasonable cost.
All six New England states have enacted various parity legislation.
However, only Massachusetts extends coverage to state employees.
Chaz Gross, executive director of NAMI Rhode Island says that even
though the state has legislation in place, treatment for mental
health services is not "truly and completely" treated the same as
other illnesses. "Limits on treatment coverage often limit vital
treatment options," he says.
He describes mental health care in R.I. as "on a collision course,"
with consumer's needs and economic reality including rising costs,
quality of care issues and increasing numbers of people entering
treatment without proper health insurance.
"Not only is this unacceptable, it's also not sustainable," Gross
adds. "I would hope that businesses in Rhode Island would realize
that eliminating arbitrary and inflexible limits on coverage for
treatment of mental illness is affordable for health plans and employers
alike and is needed for real and full parity."
Gross adds that the new study is important because it demonstrates
that implementing parity and eliminating discriminatory limits on
coverage is affordable.
|
