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Previous Volume 354:1378-1386 March 30, 2006 Number 13 Next

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ABSTRACT

Background To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits (FEHB) Program offered mental health and substance-abuse benefits on a par with general medical benefits beginning in January 2001. The plans were encouraged to manage care.

Methods We compared seven FEHB plans from 1999 through 2002 with a matched set of health plans that did not have benefits on a par with mental health and substance-abuse benefits (parity of mental health and substance-abuse benefits). Using a difference-in-differences analysis, we compared the claims patterns of matched pairs of FEHB and control plans by examining the rate of use, total spending, and out-of-pocket spending among users of mental health and substance-abuse services.

Results The difference-in-differences analysis indicated that the observed increase in the rate of use of mental health and substance-abuse services after the implementation of the parity policy was due almost entirely to a general trend in increased use that was observed in comparison health plans as well as FEHB plans. The implementation of parity was associated with a statistically significant increase in use in one plan (+0.78 percent, P<0.05) a significant decrease in use in one plan (–0.96 percent, P<0.05), and no significant difference in use in the other five plans (range, –0.38 percent to +0.23 percent; P>0.05 for each comparison). For beneficiaries who used mental health and substance-abuse services, spending attributable to the implementation of parity decreased significantly for three plans (range, –$201.99 to –$68.97; P<0.05 for each comparison) and did not change significantly for four plans (range, –$42.13 to +$27.11; P>0.05 for each comparison). The implementation of parity was associated with significant reductions in out-of-pocket spending in five of seven plans.

Conclusions When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.

Source Information

From the University of Maryland School of Medicine, Baltimore (H.H.G.); Harvard Medical School (R.G.F., H.A.H., S.-L.T.N., V.A., A.B.B.) and Harvard School of Public Health (S.-L.T.N.) — both in Boston; RAND, Santa Monica, Calif. (M.A.B.,M.S.R.); Department of Veterans Affairs, Los Angeles (A.S.Y.); UCLA School of Medicine, Los Angeles (A.S.Y.); Yale University School of Medicine, New Haven, Conn. (C.L.B.); McLean Hospital, Belmont, Mass. (A.B.B.); Westat, Rockville, Md. (S.T.A., G.M.); Northrop Grumman Information Technology, Federal Enterprise Solutions, Health Solutions, Rockville, Md. (C.L.); and CSR, Arlington, Va. (M.B.).

Address reprint requests to Dr. Goldman at the University of Maryland School of Medicine, 3700 Koppers St., Suite 402, Baltimore, MD 21227, or at hh.goldman{at}verizon.net.

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