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Pediatrics. 2013 Mar;131(3):e903-11. doi: 10.1542/peds.2012-1491. Epub 2013 Feb 18.

Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures.

Author information

1
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cbarry@jhsph.edu

Abstract

OBJECTIVE:

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act required health plans to provide mental health and substance use disorder (MH/SUD) benefits on par with medical benefits beginning in 2010. Previous research found that parity significantly lowered average out-of-pocket (OOP) spending on MH/SUD treatment of children. No evidence is available on how parity affects OOP spending by families of children with the highest MH/SUD treatment expenditures.

METHODS:

We used a difference-in-differences study design to examine whether parity reduced families' (1) share of total MH/SUD treatment expenditures paid OOP or (2) average OOP spending among children whose total MH/SUD expenditures met or exceeded the 90th percentile. By using claims data, we compared changes 2 years before (1999-2000) and 2 years after (2001-2002) the Federal Employees Health Benefits Program implemented parity to a contemporaneous group of health plans that did not implement parity over the same 4-year period. We examined those enrolled in the Federal Employees Health Benefits Program because their parity directive is similar to and served as a model for the new federal parity law.

RESULTS:

Parity led to statistically significant annual declines in the share of total MH/SUD treatment expenditures paid OOP (-5%, 95% confidence interval: -6% to -4%) and average OOP spending on MH/SUD treatment (-$178, 95% confidence interval: -257 to -97).

CONCLUSIONS:

This study provides the first empirical evidence that parity reduces the share and level of OOP spending by families of children with the highest MH/SUD treatment expenditures; however, these spending reductions were smaller than anticipated and unlikely to meaningfully improve families' financial protection.

PMID:
23420919
PMCID:
PMC3581843
DOI:
10.1542/peds.2012-1491
[Indexed for MEDLINE]
Free PMC Article

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