Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 18, Issue 1, 2015. Pages: 39-48
Published Online: 1 March 2015

Legislations and Policies to Expand Mental Health and Substance Abuse Benefits in Health Insurance Plans: A Community Guide Systematic Economic Review

Verughese Jacob,¹* Shuli Qu,² Sajal Chattopadhyay,³ Theresa Ann Sipe,⁴ John A. Knopf,⁵ Ron Z. Goetzel,⁶Ramona Finnie,⁷ Anilkrishna B. Thota,⁸ Community Preventive Services Task Force⁹

¹PhD, MPH, Service Fellow, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
²MPH, ORISE Fellow, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
³PhD, Economic Adviser, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
⁴PhD, MPH, Statistician, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
⁵MPH, ORISE Fellow, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
⁶PhD, Visiting Professor, Johns Hopkins Bloomberg School of Public Health and Vice President, Truven Health Analytics
⁷DrPH, CHES,ORISE Fellow, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
⁸MBBS, MPH, Service Fellow, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
⁹Names and affiliations of the Task Force members are at www.thecommunityguide.org/about/task-force-members.html

* Correspondence to: Verughese Jacob, Community Guide Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E69, Atlanta, GA 30333, USA.
Tel.: +1-404-498 6884
Fax: +1-404-498 0989
E-mail: hir0@cdc.gov

Source of Funding: None declared. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.

Abstract

U.S. legislative and policy initiatives have, in recent years, sought to expand mental health and substance abuse (MH/SA) benefits to achieve parity with physical health insurance benefits. The objective of this study was to assess the societal cost and economic benefit of these interventions based on a systematic review of the economic evaluation literature published from January 1950 to March 2011. The 12 included studies did not provide sufficient information to make a determination of cost-effectiveness or cost-benefit. However, the evidence showed that MH/SA benefits expansion did not lead to any substantial increase in cost to insurance plans, measured as a percentage of insurance premiums. An important limitation of this study is that the policies considered here have been superseded by even more recent and stronger parity legislations, but these have not been in place long enough to be evaluated.

Background: Health insurance plans have historically limited the benefits for mental health and substance abuse (MH/SA) services compared to benefits for physical health services. In recent years, legislative and policy initiatives in the U.S. have been taken to expand MH/SA health insurance benefits and achieve parity with physical health benefits. The relevance of these legislations for international audiences is also explored, particularly for the European context.

Aims of the Study: This paper reviews the evidence of costs and economic benefits of legislative or policy interventions to expand MH/SA health insurance benefits in the U.S. The objectives are to assess the economic value of the interventions by comparing societal cost to societal benefits, and to determine impact on costs to insurance plans resulting from expansion of these benefits.

Methods: The search for economic evidence covered literature published from January 1950 to March 2011 and included evaluations of federal and state laws or rules that expanded MH/SA benefits as well as voluntary actions by large employers. Two economists screened and abstracted the economic evidence of MH/SA benefits legislation based on standard economic and actuarial concepts and methods.

Results: The economic review included 12 studies: eleven provided evidence on cost impact to health plans, and one estimated the effect on suicides.There was insufficient evidence to determine if the intervention was cost-effective or cost-saving. However, the evidence indicates that MH/SA benefits expansion did not lead to any substantial increase in costs to insurance plans, measured as a percentage of insurance premiums.

Discussion and Limitations: This review is unable to determine the overall economic value of policies that expanded MH/SA insurance benefits due to lack of cost-effectiveness and cost-benefit studies, predominantly due to the lack of evaluations of morbidity and mortality outcomes. This may be remedied in time when long-term MH/SA patient-level data becomes available to researchers. A limitation of this review is that legislations considered here have been superseded by recent legislations that have stronger and broader impacts on MH/SA benefits within private and public insurance: Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Patient Protection and Affordable Care Act of 2010 (ACA).

Implications for Future Research: Economic assessments over the long term such as cost per QALY saved and cost-benefit will be feasible as more data becomes available from plans that implemented recent expansions of MH/SA benefits. Results from these evaluations will allow a better estimate of the economic impact of the interventions from a societal perspective. Future research should also evaluate the more downstream effects on business decisions about labor, such as effects on hiring, retention, and the offer of health benefits as part of an employee compensation package. Finally, the economic effect of the far reaching ACA of 2010 on mental health and substance abuse prevalence and care is also a subject for future research.

Received 7 August 2014; accepted 21 December 2014