1. The Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with lower average out-of-pocket (OOP) spending on mental health for children in affected insurance plans without an associated decrease in mental health service utilization.
2. The effect on average OOP spending was larger for high-spending children, but the difference was only a small fraction of average total OOP spending.
Evidence Rating Level: 2 (Good)
Study Rundown: Families of children using mental health services have experienced heavier financial burdens than families of children with health care needs of similar severity. To address this challenge, the MHPAEA went into effect in 2010 and prohibits plans from applying different standards for cost sharing, deductibles, and visit limits for mental health services than for general medical services. In this retrospective cohort study, researchers used claims data from 3 national insurers to compare mental health care costs and utilization before and after the MHPAEA among children enrolled in insurance plans affected and unaffected by the MHPAEA. Children in plans affected by parity had lower average OOP mental health spending than expected based on changes in the group not affected by parity. This effect was small compared to total average OOP mental health spending. Parity had a greater effect on families of children who spent the most on mental health, and was associated with slightly more inpatient mental health days per year. There were no other significant differences between groups in changes in mental health service utilization.
These findings are limited by the length of study period as more time may be required for the MHPAEA to be fully enforced. Furthermore, children in the 2 groups may differ, and data from only 23 states was analyzed. Nonetheless, the study is strengthened by its large, nationally representative sample. For physicians, these findings highlight the importance of considering and addressing the financial burden of mental health services on children and families even after enactment of the MHPAEA.
In-Depth [retrospective cohort]: Researchers used claims data from 3 national insurers (UnitedHealthcare, Aetna, and Humana) from the Health Care Cost Institute to identify 69 233 children aged 3 to 18 in 2008 with at least 2 uniquely dated diagnosis codes for mental health conditions between 2008 and 2012. Children with only substance use disorder diagnoses were excluded from the sample. Children in large, self-insured plans, which were subject to the MHPAEA (exposed group) were compared to children in small-group plans, which were not (comparison group). Average changes in average annual mental health spending, OOP mental health spending, OOP share of total mental health spending, number of outpatient mental health visits, number of inpatient mental health days, and average annual spending on psychotropic medications were compared in the pre-parity (2008-2009) and post-parity (2011-2012) years.
The group exposed to parity had $140 (95%CI: -$196 to -$84) lower average OOP mental health spending than expected based on changes in the comparison group. Among children in the top 85th percentile of mental health spending, parity was associated with $234 (95%CI: -$391 to -$76) lower average annual OOP mental health spending and a small increase of 0.5 (95%CI: 0.1 to 0.9) inpatient mental health days per year. There was no significant difference in average number of outpatient mental health visits or psychotropic medication spending between groups.
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