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Mental Health Insurance Parity: A View from the States

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

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Mental Health Insurance Parity: A View from the States

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  1. 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.

  2. 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

  3. 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)

  4. Mental Illness in Teens • Mental Illness in Children and Adolescents Very Common • Anxiety 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) • Substantial Delays in Receiving Treatment • Mood Disorders – 6 to 8 year latency • Anxiety Disorder – 9 – 23 year latency (PHS, 1999; Kessler et al, 2005, Wang et al 2005)

  5. The Impact of Behavioral Disorders Illustrated:Suicide is the Leading Cause of Violent Deaths Worldwide(World Health Organization, 2002) Homicide War Suicide

  6. In the United States A Person takes His/Her Life Approximately Every 16 Minutes

  7. 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% 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)

  8. Prevalence of Depression in Medical Illness Percent With Depression Medical Condition Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65 Suppl 12;3-4.

  9. Impact of Depression on Medical Cost Impact of Depression: Comorbitities Actual annual medical costs per patient based on claims data for 229,776 patients, 1995-1998. SOURCE: OCI 2001

  10. 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

  11. 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

  12. 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)

  13. 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 • Importance of Covering the ERISA Population • Effects of Managed Care • 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

  14. 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

  15. MHA State Ranking Study (cont.) • Found Significant Difference between States Parity Rating and Mental Health Service Rates. • Best or Good Parity Law = 15.8% • Limited or No Parity Law = 13.4% • 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

  16. 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.

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