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
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)
Anxiety
Substantial Delays in Receiving Treatment
Disorders – 6 to 8 year latency Anxiety Disorder – 9 – 23 year latency
Mood
(PHS, 1999; Kessler et al, 2005, Wang et al 2005)
The Impact of Behavioral Disorders Illustrated: Suicide is the Leading Cause of Violent Deaths Worldwide (World Health Organization, 2002)
Homicide
War
Suicide
5
In the United States
A Person takes His/Her Life Approximately Every 16 Minutes
6
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)
Mental Illnesses
Alcohol/Drug Use Disorders
Alzheimer’s Disease /Dementias Musculoskeletal Diseases
Respiratory Diseases
Cardiovascular Diseases
Sense Organ Diseases Injuries (Disabling) Digestive Diseases Communicable Diseases
Cancer (Malignant neoplasms) Diabetes
Migraine All Other Causes of Disability
0%
4%
8%
12%
16%
20%
24%
7
Prevalence of Depression in Medical Illness
Percent With Depression
Chronic Pain 52%
Medical Condition
MI
40%
Stroke
40%
Asthma
45%
Diabetes
27%
Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65 Suppl 12;3-4.
Impact of Depression: Impact of Depression on Medical Cost Comorbitities
Condition
Heart failure Allergic rhinitis Asthma Migraine
Back pain Diabetes Hypertension Heart Disease
Annual Medical Costs per Patient Without Depression ($)
2.56 3.27 3.73 3.82
11.61 13.06 13.38 62.40
Annual Medical Costs per Patient With Depression ($)
6.74 8.46 10.56 15.47
33.25 27.28 27.16 110.94
Actual annual medical costs per patient based on claims data for 229,776 patients, 1995-1998. SOURCE: OCI 2001
State Parity Laws
38 States/DC Have Enacted Some Form of Parity Law
5 Full or Best Parity 7 Good Parity 26 Limited Parity Laws 13 Mandate Coverage of MH Services 2 No Mandates or Parity
State Parity Laws by Year
12
Number of State Laws
10 8 6 4 2 0 State Laws
1
3
5
91
93
95
97
99
Year
7
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
Covering the ERISA Population Effects of Managed Care
Importance of
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 Rates
NSDUH,
BRFSS, CDC Suicide Rates MHA Parity Ratings for States
MHA State Ranking Study (cont.)
Found Significant Difference between States Parity Rating and Mental Health Service Rates.
or Good Parity Law = 15.8% Limited or No Parity Law = 13.4%
Best
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.