State mental health parity laws: cause or consequence of differences in use?

Health Affairs

Volumn 18, Issue 5, 1999, Pages 182-192

  Sturm, Roland ^a,b   Pacula, Rosalie Liccardo ^c  

^a RAND CORPORATION   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; HEALTH CARE ORGANIZATION; HEALTH CARE PLANNING; HEALTH MAINTENANCE ORGANIZATION; HUMAN; INSURANCE; LEGAL ASPECT; MENTAL HEALTH SERVICE; UNITED STATES; UTILIZATION REVIEW;

HEALTH CARE RATIONING; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; INSURANCE BENEFITS; MENTAL HEALTH SERVICES; STATE HEALTH PLANS; UNITED STATES; UTILIZATION REVIEW;

EID: 0039547892     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.5.182     Document Type: Article

References (24)

1. State Mental Illness Parity Laws (Arlington, Va.: National Alliance for the Mentally III, 1998).
2. R. Sturm and J. McCulloch, "Mental Health and Substance Abuse Benefits in Carve-Out Plans and the Mental Health Parity Act of 1996," Journal of Health Care Finance 24, no. 3 (1998): 84-95; and Health Care Plan Design and Cost Trends - 1988 through 1997 (Washington: Hay Group, 1998).
3. R. Sturm and J. McCulloch, "Mental Health and Substance Abuse Benefits in Carve-Out Plans and the Mental Health Parity Act of 1996," Journal of Health Care Finance 24, no. 3 (1998): 84-95; and Health Care Plan Design and Cost Trends - 1988 through 1997 (Washington: Hay Group, 1998).
4. R.G. Frank, C. Koyanagi, and T.G. McGuire, "The Politics and Economics of Mental Health 'Parity' Laws," Health Affairs (July/August 1997): 108-119.
5. See, for example, W. Goldman, J. McCulloch, and R. Sturm, "Costs and Utilization of Mental Health Sendees before and after Managed Care," Health Affairs (March/April 1998): 40-52; C.A. Ma and T.G. McGuire, "Costs and Incentives in a Mental Health Carve-Out," Health Affairs (March/April 1998): 53-69; and R. Sturm, W. Goldman, and J. McCulloch, "Mental Health and Substance Abuse Parity: A Case Study of Ohio's State Employee Program," Journal of Mental Health Policy and Economics 1, no. 3 (1998): 129-134.
6. See, for example, W. Goldman, J. McCulloch, and R. Sturm, "Costs and Utilization of Mental Health Sendees before and after Managed Care," Health Affairs (March/April 1998): 40-52; C.A. Ma and T.G. McGuire, "Costs and Incentives in a Mental Health Carve-Out," Health Affairs (March/April 1998): 53-69; and R. Sturm, W. Goldman, and J. McCulloch, "Mental Health and Substance Abuse Parity: A Case Study of Ohio's State Employee Program," Journal of Mental Health Policy and Economics 1, no. 3 (1998): 129-134.
7. See, for example, W. Goldman, J. McCulloch, and R. Sturm, "Costs and Utilization of Mental Health Sendees before and after Managed Care," Health Affairs (March/April 1998): 40-52; C.A. Ma and T.G. McGuire, "Costs and Incentives in a Mental Health Carve-Out," Health Affairs (March/April 1998): 53-69; and R. Sturm, W. Goldman, and J. McCulloch, "Mental Health and Substance Abuse Parity: A Case Study of Ohio's State Employee Program," Journal of Mental Health Policy and Economics 1, no. 3 (1998): 129-134.
8. W.S. Custer, Health Insurance Coverage and the Uninsured (Washington: Health Insurance Association of America, 1998); and G.A. Jensen and M.A. Morrisey, Mandated Benefit Laws and Employer-Sponsored Health Insurance (Washington: HIAA, 1999).
9. W.S. Custer, Health Insurance Coverage and the Uninsured (Washington: Health Insurance Association of America, 1998); and G.A. Jensen and M.A. Morrisey, Mandated Benefit Laws and Employer-Sponsored Health Insurance (Washington: HIAA, 1999).
10. F.A. Sloan and C.J. Conover, "Effects of State Reforms on Health Insurance Coverage of Adults," Inquiry 35, no. 3 (1998): 280-293.
11. R. Sturm, "How Expensive Is Unlimited Mental Health Care Coverage under Managed Care?" journal of the American Medical Association (12 November 1997): 1533-1537.
12. Custer, Health Insurance Coverage; and Sloan and Conover, "Effects of State Reforms."
13. "Mental Health Parity Act to Take Effect at Midnight" (Arlington, Va.: NAMI, 31 December 1997); and Rep. Edolphus Towns (D-NY), Congressional Record, 104th Congress, 2d sess. (24 September 1996): H10965.
14. "Mental Health Parity Act to Take Effect at Midnight" (Arlington, Va.: NAMI, 31 December 1997); and Rep. Edolphus Towns (D-NY), Congressional Record, 104th Congress, 2d sess. (24 September 1996): H10965.
15. Sturm, "How Expensive Is Unlimited Coverage?;" and C.R. Gresenz, X.F. Liu, and R. Sturm, "Managed Behavioral Health Services for Children under CarveOut Contracts," Psychiatric Services 49, no. 8 (1998): 1054-1058.
16. Sturm, "How Expensive Is Unlimited Coverage?;" and C.R. Gresenz, X.F. Liu, and R. Sturm, "Managed Behavioral Health Services for Children under CarveOut Contracts," Psychiatric Services 49, no. 8 (1998): 1054-1058.
17. Authors' calculations.
18. William Goldman, senior vice-president, United Behavioral Health, personal communication, August 1998.
19. R. Sturm et al., "The Design of Health Care for Communities: A Study of Health Care Delivery for Alcohol, Drug Abuse, and Mental Health Conditions," Inquiry 36, no. 3 (1999); and P. Kemper et al., "The Design of the Community Tracking Study: A Longitudinal Study of Health System Change and Its Effects on People," Inquiry 33, no. 2 (1996): 195-206.
20. R. Sturm et al., "The Design of Health Care for Communities: A Study of Health Care Delivery for Alcohol, Drug Abuse, and Mental Health Conditions," Inquiry 36, no. 3 (1999); and P. Kemper et al., "The Design of the Community Tracking Study: A Longitudinal Study of Health System Change and Its Effects on People," Inquiry 33, no. 2 (1996): 195-206.
21. The items were based on a initial screener question of any mental health use and then more detailed questions on specialty use among any users. This differs from the survey approaches in the Epidemiologic Catchment Area (ECA) study and the National Comorbidity Study (NCS), which asked about use for specific providers and then summed up. However, one can construct HCC items that are comparable to the NCS (not reported here), and the utilization rates are then comparable. See R.C. Kessler et al., "Past-Year Use of Outpatient Services for Psychiatric Problems in the National Comorbidity Survey," American Journal of Psychiatry 156, no. 1 (1999): 115-123; and D.A. Regier et al., "The de facto U.S. Mental and Addictive Disorders Service System," Archives of General Psychiatry 50, no. 2 (1993): 85-94.
22. The items were based on a initial screener question of any mental health use and then more detailed questions on specialty use among any users. This differs from the survey approaches in the Epidemiologic Catchment Area (ECA) study and the National Comorbidity Study (NCS), which asked about use for specific providers and then summed up. However, one can construct HCC items that are comparable to the NCS (not reported here), and the utilization rates are then comparable. See R.C. Kessler et al., "Past-Year Use of Outpatient Services for Psychiatric Problems in the National Comorbidity Survey," American Journal of Psychiatry 156, no. 1 (1999): 115-123; and D.A. Regier et al., "The de facto U.S. Mental and Addictive Disorders Service System," Archives of General Psychiatry 50, no. 2 (1993): 85-94.
23. K.B. Wells et al., Caring for Depression (Cambridge, Mass.: Harvard University Press, 1996).
24. The rate of uninsurance is less than in other recent national studies. For example, Sloan and Conover report uninsurance rates of 18 percent in the early 1990s. Sloan and Conover, "Effects of State Reforms." Some of this may be due to differences in surveys, but the strong economy and low unemployment rates together with stable or even decreasing health care costs to employers are likely to have reduced the number of persons without insurance. The Bureau of Labor Statistics civilian labor force unemployment rate dropped from 7.8 percent in June 1992 (about the middle of the period analyzed by Sloan and Conover) to 4.5 percent in June 1998 during the HCC survey period.