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Use of mental health services greater in health plans with parity in cost sharing, data find

Friday, January 09 2009 | Comments
Evidence Grade 0 What's This?
Medicare beneficiaries who are enrolled in health plans with equivalent cost sharing for mental health and general health conditions appear to exhibit greater use of timely outpatient mental health services following a psychiatric hospitalization as compared with enrollees in plans without parity in cost sharing, according to new evidence.

In 2008, Congress enacted legislation to require parity in benefits for mental health and general health services among group health plans covering more than 50 employees, as well as Medicare Part B plans, to be phased in by 2010.

In the current study, researchers evaluated cost-sharing requirements for outpatient mental health and general medical services for 302 Medicare plans from 2001 to 2006. In addition, they analyzed the relationship between mental health parity and the use of mental health follow-up care following a psychiatric hospitalization for 43,892 individuals (48,078 plan observations) in 173 Medicare plans from 2002 through 2006. Nearly 50 percent of the observations involved Medicare plans with no mental health parity, but 32 percent had intermediate parity and 21 percent had full parity.

From 2001 to 2006, the mean copayment for a mental health-related outpatient visit was $20.36, while the mean copay for a primary care visit was $10.04. More mental health visits also required coinsurance versus primary care or specialist visits (14 percent vs. 2 percent).

Results showed that patients enrolled in full-parity health plans were more likely to receive outpatient mental health care within seven and 30 days after being hospitalized for a mental illness as compared with enrollees in Medicare plans with no or intermediate parity.

Further, rates of seven-day follow-up mental health care were higher in plans requiring copays of $15 or less versus plans requiring copays of more than $30 (37.5 percent vs. 29.6 percent).

The researchers noted that the link between mental health parity and follow-up care was stronger among enrollees who lived in low-income areas and areas with less education.

Rates of follow-up mental health care dropped by 7.7 percentage points in 10 plans that discontinued parity and increased by 7.5 percentage points in 10 control plans that maintained full parity.

The study was published in the Dec. 24/31 edition of JAMA.

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