Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 13, Issue 4, 2010. Pages: 167-174
Published Online: 30 December 2010

The Effect of Employee Assistance Plan Benefits on the Use of Outpatient Behavioral Health Care

Dominic Hodgkin,¹* Elizabeth L. Merrick,² Deirdre Hiatt,³ Constance M. Horgan,⁴ Thomas G. McGuire⁵

¹Ph.D., Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
²Ph.D., MSW, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
³Ph.D., Managed Health Network, Richmond, CA, USA
⁴Sc.D., Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
⁵Ph.D., Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

* Correspondence to: Dominic Hodgkin, Institute for Behavioral Health, Heller School of Social Policy and Management, Mailstop 35, Brandeis University, 415 South St, Waltham MA 02454-9110, USA
Tel.: +1-781-736 8551
Fax: +1-781-736 3985
E-mail: hodgkin@brandeis.edu

Source of Funding: This study was funded by the National Institute on Drug Abuse grant # P50-DA-010233.

Abstract

Many US workers have access both to an employee assistance plan (EAP) and to employer health insurance that includes behavioral health services. We examine whether EAP services substitute for outpatient behavioral health care services covered by the health plan, in settings where the employer has purchased both products jointly. We analyze administrative data for 26,464 patients enrolled with a managed behavioral health organization in 2005. General linear models are used to predict visits and spending for regular outpatient care. We also use instrumental variable analysis to test for endogeneity of the number of EAP visits covered. Having more generous EAP coverage predicts fewer regular outpatient visits, and lower spending for outpatient care. This supports the idea that the two types of care are to some extent perceived as substitutes, although patients also appear to perceive that EAP services offer something distinct from regular outpatient care.

Background: Nearly half of all US workers have access to an employee assistance plan (EAP). At the same time, most large US employers also purchase health benefits for their employees, and these benefits packages typically include behavioral health services. There is some potential overlap in services covered by the EAP and the health plan, and some employers choose to purchase the two jointly as an `integrated product'. It is not clear whether EAP services substitute for outpatient behavioral health care services covered by the health plan.

Aim of the Study: To evaluate how the number of EAP visits covered affects the use of regular outpatient behavioral health care (number of visits, and total spending), in an integrated product setting.

Methods: Analysis of claims, eligibility and benefits data for 26,464 users of behavioral health care for the year 2005. For both EAP and regular behavioral health care, the individuals were enrolled with Managed Health Network (MHN), a large national specialty insurance plan. Multivariate regression analyses were performed to investigate the determinants of the number of regular outpatient visits, and spending for regular outpatient care. To address skewness in the dependent variables, the estimation used generalized linear models with a log link. A limited instrumental variable analysis was used to test for endogeneity of the number of EAP visits covered.

Results: Nearly half the enrollees in this sample were in employer plans that allowed 4-5 EAP visits per treatment episode, and 31% were allowed 3 EAP visits per year. Having an EAP visit allowance of 4-5 sessions per episode predicts fewer regular outpatient visits, compared with having an allowance of 3 sessions per year. More generous EAP allowances also reduce payments for outpatient care, with one exception.

Discussion: Greater availability of EAP benefits appears to reduce utilization of regular outpatient care, supporting the idea that the two types of care are to some extent perceived as substitutes. One limitation of this study is its cross-sectional nature, since the relationships observed could reflect the effect of other unmeasured variables. Also, the data are from a single managed behavioral health organization, limiting generalizability somewhat, although many employers are represented in the data.

Implications for Health Policy: The results should discourage employers from either eliminating EAP benefits as duplicative, or replacing behavioral health benefits with an expanded EAP. Patients appear to perceive that EAP services offer something distinct from regular outpatient care.

Implications for Further Research: Future studies should see whether these results are reproduced, ideally by looking at employer plans with a wider range of EAP visit allowances.

Received 20 November 2009; accepted 8 November 2010