Effects of Mental Parity on High-Cost and Severely-Ill Individuals

心理平等对高成本和重病患者的影响

• 批准号: 7576323
• 负责人: HAIDEN A. HUSKAMP
• 金额: $ 41.31万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-12-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7576323
• 关键词: Accounting; Acute; Address; Adjustment Disorders; Adoption; Adult; Advocate; Affect; Bipolar Disorder; Calendar; Caring; Chronic; Cost Sharing; Data; Databases; Deductibles; Diagnosis; Disadvantaged; Disease; Employee Health; Employee Health Benefit Plans; Evaluation; Expenditure; Experimental Designs; Goals; Guidelines; Hazard Models; Health Benefit; Health Insurance; Health Planning; Health Services Accessibility; Heterogeneity; Individual; Inpatients; Insurance; Insurance Coverage; Left; Literature; Logistic Regressions; Major Depressive Disorder; Managed Care; Marketing; Medical; Mental Health; Mental disorders; Modeling; Nature; Outpatients; Patients; Personnel Management; Policies; Policy Maker; Probability; Psyche structure; Psychotropic Drugs; Relative (related person); Risk; Services; Severities; Substance abuse problem; Treatment Cost; Visit; base; burden of illness; comparison group; cost; experience; improved; parity; programs; response; severe mental illness; trend

DESCRIPTION (provided by applicant): A hallmark of a well-functioning insurance market is protection against the risk of catastrophic financial losses. Historically, protection from large losses resulting from mental health/substance abuse (MH/SA) service use has been unavailable in most private health insurance plans because of special benefit limits on MH/SA services. Parity policies aim to protect individuals with severe mental illnesses against the catastrophic costs of seeking treatment, and, in doing so, increase efficiency and fairness in the insurance market. In 2001, all plans participating in the Federal Employees Health Benefits (FEHB) Program were required to offer coverage for MH/SA services on a par with general medical services. The FEHB parity directive represents the most comprehensive parity policy enacted to date. Previous studies of parity have found that, on average, implementation of MH/SA parity did not result in either the large increases in MH/SA spending predicted by opponents or increased access to services anticipated by mental health advocates. Parity has resulted in relatively small reductions in average out-of-pocket spending for service users. It is possible that the relatively small changes in average out-of-pocket spending resulting from parity adoption were driven by the subset of individuals with the highest costs; however, this issue has not been examined. The impact of parity on the sickest individuals and those carrying the greatest financial burden of illness constitutes the central question left unanswered by the existing literature on parity. The specific aims of this application are to: 1) Compare the effects of comprehensive parity on total and out-of-pocket MH/SA spending across the distribution of expenditures in order to determine whether parity differentially increased financial protection for individuals with high MH/SA expenditures; 2) Examine the effect of comprehensive parity on the composition and intensity of the treatment they receive; and 3) Assess the effect of parity on the likelihood of being rehospitalized for an MH/SA condition and the likelihood that patients diagnosed with bipolar disorder or major depression receive appropriate ambulatory treatment. We will use a quasi-experimental design to compare FEHB plan enrollees with a matched comparison group of privately-insured enrollees not subject to the FEHB parity directive to account for secular trends in MH/SA use and spending. We will attempt to disentangle the effects of parity and managed care carve-outs by comparing plans that used carve-outs with those that did not. We will estimate a combination of two-part random-effects models for longitudinal data, latent class random-effects models, logistic regression models, Poisson regression models, and hazard models to address these aims.

描述（由申请人提供）：运作良好的保险市场的一个标志是防范灾难性财务损失的风险。从历史上看，由于 MH/SA 服务的特殊福利限制，大多数私人健康保险计划都无法保护因使用心理健康/药物滥用 (MH/SA) 服务而造成的巨大损失。平价政策旨在保护患有严重精神疾病的个人免受寻求治疗的灾难性费用，并以此提高保险市场的效率和公平性。 2001 年，所有参与联邦雇员健康福利 (FEHB) 计划的计划都必须提供与一般医疗服务同等的 MH/SA 服务承保。 FEHB 平价指令代表了迄今为止颁布的最全面的平价政策。之前对均等的研究发现，平均而言，实施 MH/SA 均等并不会导致反对者预测的 MH/SA 支出大幅增加，也不会导致心理健康倡导者预期的服务获取机会增加。平价导致服务用户的平均自付费用相对较小地减少。平价采用带来的平均自付费用相对较小的变化可能是由成本最高的个人子集驱动的；然而，这个问题尚未得到审查。均等对病情最严重的个人和承受最大疾病经济负担的人的影响构成了现有关于均等文献尚未回答的核心问题。本应用的具体目标是： 1) 比较综合平价对支出分配中的 MH/SA 总支出和自付费用的影响，以确定平价是否有差异地增加了对 MH/SA 高的个人的财务保护。 SA 支出； 2）检查综合平价对他们接受的治疗的构成和强度的影响； 3) 评估产次对因 MH/SA 病症再次住院的可能性以及诊断为双相情感障碍或重度抑郁症的患者接受适当门诊治疗的可能性的影响。我们将使用准实验设计将 FEHB 计划参与者与不受 FEHB 平价指令约束的私人保险参与者的匹配对照组进行比较，以考虑 MH/SA 使用和支出的长期趋势。我们将尝试通过比较使用剥离的计划和未使用剥离的计划来理清均等和管理式医疗剥离的影响。我们将估计纵向数据的两部分随机效应模型、潜在类随机效应模型、逻辑回归模型、泊松回归模型和风险模型的组合来实现这些目标。