Insurance Financing Increased For Mental Health Conditions But Not For Substance Use Disorders, 1986–2014

Abstract

This study updates previous estimates of US spending on mental health and substance use disorders through 2014. The results reveal that the long-term trend of greater insurance financing of mental health care continued in recent years. The share of total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44 percent in 1986 to 68 percent in 2014. In contrast, the share of spending for substance use disorder treatment financed by private insurance, Medicare, and Medicaid was 45 percent in 1986 and 46 percent in 2014. From 2004 to 2013, a growing percentage of adults received mental health treatment (12.6 percent and 14.6 percent, respectively), albeit only because of the increased use of psychiatric medications. In the same period, only 1.2-1.3 percent of adults received substance use disorder treatment in inpatient, outpatient, or residential settings, although the use of medications to treat substance use disorders increased rapidly.

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

“…Payers of treatment for OUDs include shifting combinations of public funds including the federal block grant, public and private health insurance, and out-of-pocket spending by individuals or their families (Mark et al 2016). Compared to mental health, SUD treatment has been less likely to be paid for by health insurance and more likely to receive funding directly from public agencies.…”

“…Compared to mental health, SUD treatment has been less likely to be paid for by health insurance and more likely to receive funding directly from public agencies. In 2014, only 18% of substance use treatment expenditures were paid for by private insurance (Mark et al 2016). Nonetheless, private insurance remains an important funding source, and with recent reforms such as the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) and the 2010 Affordable Care Act (ACA), it has been anticipated that private insurance coverage would expand (Volkow et al 2014) for people with SUDs.…”

“…(Ali, Teich & Mutter 2015; Busch et al 2014; Creedon & Cook 2016; Saloner et al 2016; Thalmayer et al 2016). Other barriers such as stigma, variation in treatment availability, and the unique degree to which SUD treatment is paid for by sources other than private health insurance were not immediately addressed by MHPAEA and the ACA (Ali, Teich & Mutter 2015; Mark et al 2016). …”

Medications for substance use disorders (SUD): emerging approaches

“…Several major trends are currently observed in this area. Firstly, an increasing amount of prescriptions for certain medications for opioid use disorders (e.g., buprenorphine-naloxone), have been observed, versus stable use of other effective medications, such as methadone [7]. Secondly, medications for alcohol use disorders are used only to a limited extent [8,9].…”

“…Secondly, medications for alcohol use disorders are used only to a limited extent [8,9]. Thirdly, expenditures for SUD pharmacotherapies remains low, compared to overall expenditures in the care of these disorders [7]. …”