Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures

Colleen L Barry, Alyna T. Chien, Sharon Lise T Normand, Alisa B. Busch, Vanessa Azzone, Howard H. Goldman, Haiden A. Huskamp

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act required health plans to provide mental health and substance use disorder (MH/SUD) benefits on par with medical benefits beginning in 2010. Previous research found that parity significantly lowered average out-of-pocket (OOP) spending on MH/SUD treatment of children. No evidence is available on how parity affects OOP spending by families of children with the highest MH/SUD treatment expenditures. METHODS: We used a difference-in- differences study design to examine whether parity reduced families' (1) share of total MH/SUD treatment expenditures paid OOP or (2) average OOP spending among children whose total MH/SUD expenditures met or exceeded the 90th percentile. By using claims data, we compared changes 2 years before (1999-2000) and 2 years after (2001-2002) the Federal Employees Health Benefits Program implemented parity to a contemporaneous group of health plans that did not implement parity over the same 4-year period. We examined those enrolled in the Federal Employees Health Benefits Program because their parity directive is similar to and served as a model for the new federal parity law. RESULTS: Parity led to statistically significant annual declines in the share of total MH/SUD treatment expenditures paid OOP (25%, 95% confidence interval: -6% to -4%) and average OOP spending on MH/SUD treatment (-$178, 95% confidence interval: -257 to -97). CONCLUSIONS: This study provides the first empirical evidence that parity reduces the share and level of OOP spending by families of children with the highest MH/SUD treatment expenditures; however, these spending reductions were smaller than anticipated and unlikely to meaningfully improve families' financial protection.

Original languageEnglish (US)
JournalPediatrics
Volume131
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Health Expenditures
Parity
Substance-Related Disorders
Mental Health
Insurance Benefits
Occupational Health
Therapeutics
Expenditure
Substance Abuse
Confidence Intervals
Substance Use
Health

Keywords

  • Insurance
  • Mental health
  • Parity
  • Substance use disorder

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Barry, C. L., Chien, A. T., Normand, S. L. T., Busch, A. B., Azzone, V., Goldman, H. H., & Huskamp, H. A. (2013). Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. Pediatrics, 131(3). https://doi.org/10.1542/peds.2012-1491

Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. / Barry, Colleen L; Chien, Alyna T.; Normand, Sharon Lise T; Busch, Alisa B.; Azzone, Vanessa; Goldman, Howard H.; Huskamp, Haiden A.

In: Pediatrics, Vol. 131, No. 3, 03.2013.

Research output: Contribution to journalArticle

Barry, Colleen L ; Chien, Alyna T. ; Normand, Sharon Lise T ; Busch, Alisa B. ; Azzone, Vanessa ; Goldman, Howard H. ; Huskamp, Haiden A. / Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. In: Pediatrics. 2013 ; Vol. 131, No. 3.
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abstract = "OBJECTIVE: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act required health plans to provide mental health and substance use disorder (MH/SUD) benefits on par with medical benefits beginning in 2010. Previous research found that parity significantly lowered average out-of-pocket (OOP) spending on MH/SUD treatment of children. No evidence is available on how parity affects OOP spending by families of children with the highest MH/SUD treatment expenditures. METHODS: We used a difference-in- differences study design to examine whether parity reduced families' (1) share of total MH/SUD treatment expenditures paid OOP or (2) average OOP spending among children whose total MH/SUD expenditures met or exceeded the 90th percentile. By using claims data, we compared changes 2 years before (1999-2000) and 2 years after (2001-2002) the Federal Employees Health Benefits Program implemented parity to a contemporaneous group of health plans that did not implement parity over the same 4-year period. We examined those enrolled in the Federal Employees Health Benefits Program because their parity directive is similar to and served as a model for the new federal parity law. RESULTS: Parity led to statistically significant annual declines in the share of total MH/SUD treatment expenditures paid OOP (25{\%}, 95{\%} confidence interval: -6{\%} to -4{\%}) and average OOP spending on MH/SUD treatment (-$178, 95{\%} confidence interval: -257 to -97). CONCLUSIONS: This study provides the first empirical evidence that parity reduces the share and level of OOP spending by families of children with the highest MH/SUD treatment expenditures; however, these spending reductions were smaller than anticipated and unlikely to meaningfully improve families' financial protection.",
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AB - OBJECTIVE: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act required health plans to provide mental health and substance use disorder (MH/SUD) benefits on par with medical benefits beginning in 2010. Previous research found that parity significantly lowered average out-of-pocket (OOP) spending on MH/SUD treatment of children. No evidence is available on how parity affects OOP spending by families of children with the highest MH/SUD treatment expenditures. METHODS: We used a difference-in- differences study design to examine whether parity reduced families' (1) share of total MH/SUD treatment expenditures paid OOP or (2) average OOP spending among children whose total MH/SUD expenditures met or exceeded the 90th percentile. By using claims data, we compared changes 2 years before (1999-2000) and 2 years after (2001-2002) the Federal Employees Health Benefits Program implemented parity to a contemporaneous group of health plans that did not implement parity over the same 4-year period. We examined those enrolled in the Federal Employees Health Benefits Program because their parity directive is similar to and served as a model for the new federal parity law. RESULTS: Parity led to statistically significant annual declines in the share of total MH/SUD treatment expenditures paid OOP (25%, 95% confidence interval: -6% to -4%) and average OOP spending on MH/SUD treatment (-$178, 95% confidence interval: -257 to -97). CONCLUSIONS: This study provides the first empirical evidence that parity reduces the share and level of OOP spending by families of children with the highest MH/SUD treatment expenditures; however, these spending reductions were smaller than anticipated and unlikely to meaningfully improve families' financial protection.

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