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APHA Scientific Session and Event Listing

Dominic Hodgkin, PhD, Constance M. Horgan, ScD, Deborah W. Garnick, ScD, and Elizabeth L. Merrick, PhD. Schneider Institute for Health Policy, Brandeis University, 415 South St, Mailstop 035, Waltham, MA 02454, (781) 736 8551, hodgkin@brandeis.edu

Insurers have traditionally covered mental health and substance abuse care less generously than general medical care. Concerned that this discourages needed care, advocates and others have promoted legislation requiring 'parity' in coverage between behavioral health and general medical care. Many state laws require equal cost-sharing (copays and coinsurance), the benefits feature that affects most users - however, many people are not covered by these laws. At the same time, some hoped that the shift to managed care would reduce cost-sharing, now that plans have other tools with which to control utilization.

Our study measures the levels of cost-sharing that private health plans require for mental health, substance abuse and general medical care. Results are from our 2003 survey of 368 commercial health plans in 60 US market areas regarding behavioral health care, yielding national estimates of plan features (83% response rate); and from our comparable survey in 1999.

Between 1999 and 2003 there were notable shifts in plans' cost-sharing for these services. High cost sharing (copayments greater than $20 or coinsurance greater than 20%) has become more common since 1999 for both behavioral health and general medical services. The proportion of products requiring a higher level of cost sharing increased from 26% to 42% for MH/SA, and increased even more substantially for medical care from 4% to 41%. The difference in cost-sharing between medical and behavioral health care has shrunk (a form of parity), but this is due to rising medical cost sharing - not what parity proponents had sought.

Learning Objectives: