Mental Health Insurance Parity: A View from the States David L. Shern, Ph.D. President/CEO Mental...
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Transcript of Mental Health Insurance Parity: A View from the States David L. Shern, Ph.D. President/CEO Mental...
Mental Health Insurance Parity: A View from the States
David L. Shern, Ph.D.
President/CEO Mental Health America
Academy Health Policy Conference
February 5, 2008
Washington, D.C.
Overview of the Presentation
Importance of Insurance Coverage for Mental Health and Substance Use Conditions
Enactment of State Parity Laws Relative to the 1996 Federal Act
Characteristics of State Laws Relationships to
Utilization Outcomes
U.S. Has Highest Rates of Mental Illness
U.S. has the highest prevalence rates (26%) in the world in a comparison of 14 developing and developed countries. (JAMA, 2004)
Mental Illness in Teens Mental Illness in Children and Adolescents Very
Common Anxiety Disorders – 13.0% (Median age of onset 11) Mood Disorders – 6.2% (Median age of onset 30) Disruptive Disorder – 10.3% (Median age of onset 11) Substance Use – 2.0% (Median age of onset 20) Any Disorder – 20.9% (Median age of onset 14)
Substantial Delays in Receiving Treatment Mood Disorders – 6 to 8 year latency Anxiety Disorder – 9 – 23 year latency
(PHS, 1999; Kessler et al, 2005, Wang et al 2005)
5
The Impact of Behavioral Disorders Illustrated:Suicide is the Leading Cause of Violent Deaths Worldwide
(World Health Organization, 2002)
S u i c i d e HomicideWar-related deaths
Homicide War
Suicide
6
In the United States
A Person takes His/Her Life Approximately Every 16
Minutes
70% 4% 8% 12
%16% 20% 24%
All Other Causes of Disability
Migraine
Diabetes
Cancer (Malignant neoplasms)
Communicable Diseases
Digestive Diseases
Injuries (Disabling)
Sense Organ Diseases
Cardiovascular Diseases
Respiratory Diseases
Musculoskeletal Diseases
Alzheimer’s Disease /Dementias
Alcohol/Drug Use Disorders
Mental Illnesses
The Impact of Behavioral Disorders Illustrated:The Disability Impact of Mental Illness
Illness Related Disability--United States, Canada, and Western Europe, 2000 (World Health Organization, 2001)
27%
45%
40%
40%
52%
Diabetes
Asthma
Stroke
MI
Chronic Pain
Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65 Suppl 12;3-4.
Me
dic
al C
on
dit
ion
Percent With Depression
Prevalence of Depression in Medical Illness
Impact of Depression: Comorbitities
Condition
Annual Medical Costs per Patient
Without Depression ($)
Annual Medical Costs per Patient
With Depression ($)
Heart failure 2.56 6.74
Allergic rhinitis 3.27 8.46
Asthma 3.73 10.56
Migraine 3.82 15.47
Back pain 11.61 33.25
Diabetes 13.06 27.28
Hypertension 13.38 27.16
Heart Disease 62.40 110.94
Actual annual medical costs per patient based on claims data for 229,776 patients, 1995-1998.SOURCE: OCI 2001
Impact of Depression on Medical Cost
State Parity Laws
38 States/DC Have Enacted Some Form of Parity Law 5 Full or Best Parity 7 Good Parity 26 Limited Parity Laws13 Mandate Coverage of MH Services 2 No Mandates or Parity
State Parity Laws by Year
0
2
4
6
8
10
12
Year
Nu
mb
er
of
Sta
te L
aw
s
State Laws
Variations in Parity Laws
Best Parity Laws (5) Applies to All Mental Health and Substance Use
Condition No exemptions for Small Employers or Cost
Increases Same Benefits as General Health Conditions
Co-pays Limits
Good Parity Laws (7) Often Exclude Substance Use Conditions Include Some Exemptions
Variations in Parity Laws (cont)
Limited Parity Laws (26 States)Apply to Select Groups
Often Persons with Serious Mental Health Diagnoses (Schizophrenia, Bi-Polar Illness, etc.)
Includes Exemptions Often Excludes Substance Use Conditions
No Parity but Mandates MH Services (13) No Parity or Mandates (2)
Variable Estimates of Effect on Service Utilization in States Earlier Analyses by Sturm and Colleagues
(2000, 2004, 2004)Showed Limited to No Effect on Utilization Importance of Covering the ERISA Population Effects of Managed Care
More Recent Analyses by Harris et al. (2006) Increase Utilization of Mental Health Services Particularly for Individuals with Mild to Moderate
Disorders Perhaps Indicative of Greater Penetration of Parity
Laws in more Recent Years
Mental Health America Ranking Study – Depression and Suicide Integrated Data from Several National
Data Sets to Examine Relationships between System Characteristics, Depression and Suicide RatesNSDUH, BRFSS, CDC Suicide RatesMHA Parity Ratings for States
MHA State Ranking Study (cont.)
Found Significant Difference between States Parity Rating and Mental Health Service Rates. Best or Good Parity Law = 15.8% Limited or No Parity Law = 13.4%
Significant Negative Correlation between Mental Health Service Rate and Suicide Rate
Significant Positive Correlation between Rates of Depression and Service Use
Several Other Indicators or System Capacity Related to Decreased Rates of Suicide and Depression
Conclusions
MHSU Conditions Prevalent, Disabling and Expensive
State Parity Laws appear to have Increased Rates of Mental Health Service Use
Utilization of Services may be Linked to Positive Health and Behavioral Health Status in the Population.