报告题目：Does Mental Health Parity Encourage Mental Health Utilization among Children? Evidence from the 2008 Mental Health Parity Law
报告人简介：马芥， 金禾经济研究中心助理教授，2016年在印第安纳大学获得经济学博士学位。研究方向为：健康经济学, 医疗卫生政策，应用计量经济学。
Abstract: Insurance coverage of mental health services suffers from a long history of inadequacy compared to other medical benefits. The Kaiser Family Foundation’s national employer survey showed that the large majority of covered workers were still subject to special mental health day and visit limits in 2002 (Barry et al. 2003). This inadequate coverage has led to access barriers among critical populations, especially children. The 2005-2006 National Survey of Children with Special Health Care Needs (NSCSHCN) data showed that around 20% of children needing mental health care were not receiving all needed mental care.
The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) prevents “group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical or surgical benefits”, effective for plan years beginning after October 3, 2009. However, prior evidence of the effect of the mental health parity provision similar to the MHPAEA lacks consensus. Azrin et al. (2007) found that state mental parity had very little effect on the use of children's mental service, but Harris, Carpenter, and Bao (2006) found that the state parity laws increased the probability of using any mental health among the lower and middle distress group.
There are important limitations of state parity laws. On one hand, the state mandates have exemptions for self-insured plans and small employers (Buchmueller et al. 2007). On the other hand, there is the concern of policy endogeneity such that states with below-average utilization were more likely to enact state legislation of mental parity (Sturm and Pacula 1999).
We use the 2007 and 2011-2012 waves of the National Survey of Children's Health (NSCH) data and a difference-in-difference design comparing states with prior mental parity laws to those without prior parity provision before and after 2008, to examine the effect of the federal parity law on utilization of mental health services among children, as well as their mental health. In contrast with previous evidence of the modest effect of state parity laws, our evidence suggests that the parity provision resulted in 2.39 percentage points increase in mental health care utilization among children from families with income levels of 185%-400% federal poverty level. This represents a substantial increase, about 30% of the prior utilization level (2.39/7.93). In addition, there is a reduction in the proportion delayed mental health care services.
Subgroup analyses are consistent with the hypothesis that the federal parity law increases access to mental health service for those with private group plans. Firstly, the effect shows up only for those with insurance access. Secondly, the effect is concentrated among white children and children whose mothers are at least high school graduates. Lastly, the effect is larger for children of age 6 and older. As Medicaid coverage becomes less generous after the age of 6, more children would be shifted to private insurance and thus affected by the parity law.
Azrin, Susan T., Haiden A. Huskamp, Vanessa Azzone, Howard H. Goldman, Richard G. Frank, M. Audrey Burnam, Sharon-Lise T. Normand, et al. 2007. “Impact of Full Mental Health and Substance Abuse Parity for Children in the Federal Employees Health Benefits Program.” Pediatrics 119 (2).
Barry, Colleen L, Jon R Gabel, Richard G Frank, Samantha Hawkins, H Heidi, Jeremy D Pickreign, Colleen L Barry, et al. 2003. “Design Of Mental Health Benefits: Still Unequal After All These Years.” Health Affairs.
Buchmueller, Thomas C., Philip F. Cooper, Mireille Jacobson, and Samuel H. Zuvekas. 2007. “Trends: Parity for Whom? Exemptions and the Extent of State Mental Health Parity Legislation.” Health Affairs 26 (4): w483-7.
Harris, Katherine M, Christopher Carpenter, and Yuhua Bao. 2006. “The Effects of State Parity Laws on the Use of Mental Health Care” 44 (6): 499–505.
McConnell, K. John, Samuel H.N. Gast, M. Susan Ridgely, Neal Wallace, Natalie Jacuzzi, Traci Rieckmann, Bentson H. McFarland, and Dennis McCarty. 2012. “Behavioral Health Insurance Parity: Does Oregon’s Experience Presage the National Experience With the Mental Health Parity and Addiction Equity Act?” American Journal of Psychiatry 169 (1): 31–38.
Sturm, R, and R L Pacula. 1999. “State Mental Health Parity Laws: Cause or Consequence of Differences in Use?” Health Affairs 18 (5): 182–92.