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Med Care. 2019 Apr;57(4):245-255. doi: 10.1097/MLR.0000000000001076.

Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services.

Author information

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI.
Stanford Law School and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston.
McLean Hospital, Belmont.
Departments of Psychiatry.
Health Care Policy, Harvard Medical School, Boston, MA.



Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act.


To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers.


Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group.


Commercially insured enrollees aged 18-64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1-2 years postpolicy.


Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations.


Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, respectively. Corresponding annual mental health visits increased by 0.31 (0.12, 0.51) and 0.59 (0.37, 0.81) per enrollee. Difference-in-difference changes were larger for the highest baseline quartile mental health care utilizers [year 2: 0.76 visits per enrollee (0.14, 1.38); relative increase 10.07%] and spenders [year 2: $-2.28 (-3.76, -0.79); relative reduction 5.91%]. There were no significant difference-in-differences changes in emergency department visits or hospitalizations.


In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity.

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