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A Misleading Suggestion Of Increased Utilization From Mental Health Parity

April 10th, 2013
by Howard Goldman

The Mental Health Parity and Addictions Equity Act of 2008 (MHPAEA) prohibits group health plans that cover mental health and substance abuse treatment from imposing higher cost-sharing requirements for these benefits, as compared to cost-sharing requirements for other conditions. Rigorous studies from Oregon and the Federal Employees Health Benefits Program have not found that similar parity requirements resulted in increased costs.

A recent report from the Health Care Cost Institute (HCCI) has been widely interpreted as suggesting that the MHPAEA and an interim final rule (IFR) implementing the statute caused an increase in hospital inpatient admissions for psychiatric conditions. However, the report does not support this interpretation.

The HCCI released its report on trends in inpatient psychiatric admissions as if it evaluated the impact of the MHPAEA. But the report simply juxtaposes a longstanding trend of increasing hospitalization for psychiatric conditions between 2007 and 2011 with the observation that the MHPAEA and its Interim Final Rule (IFR) were implemented at the end of 2010 and in 2011. This tells us nothing useful about the impact of the MHPAEA. In contrast, the FEHB Program and Oregon studies, which did not find cost increases attributable to parity, analyzed time periods just prior to policy implementation and just following implementation, and they controlled for the secular trend of increasing psychiatric admissions, using a difference-in-differences analytic strategy.

The title of the HCCI report, The Impact of the Mental Health Parity and Addictions Equity Act on Inpatient Admissions, exacerbates the problem, creating the impression that the increase in admissions was caused by the MHPAEA and the IFR.  However, the rise in inpatient admissions began as early as 2007 and has increased monotonically over all 5 years observed. The design of the HCCI study is not adequate to assess the impact of the MHPAE and its IFR.

The HCCI adds a caveat to its conclusion: “The role played by the MHPAEA and the IFR in growing spending and utilization is not clear.” While truer words have not been spoken on this important policy matter, the damage reflected in the title has already been done. The HCCI report has done a disservice to a proper analysis of the impact of the MHPAEA.

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1 Trackback for “A Misleading Suggestion Of Increased Utilization From Mental Health Parity”

  1. New Study Shows Increased Access to Substance Use Disorder Treatment After Federal Parity | Maryland Parity Project
    April 11th, 2013 at 12:20 pm

1 Response to “A Misleading Suggestion Of Increased Utilization From Mental Health Parity”

  1. dnewman Says:

    Howard was spot on, titles matter, and HCCI should have done a better job captioning the issue brief.
    We certainly never intend to mislead and take his comments to heart.

    David Newman, Executive Director, HCCI

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