Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans

Abstract

BACKGROUND AND OBJECTIVES: Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. METHODS: Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007–2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. RESULTS: Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010–2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. CONCLUSIONS: Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans.

The Mental Health Parity and Addiction Equity Act evaluation study: Child and adolescent behavioral health service expenditures and utilization

“…To our knowledge, only one MHPAEA study has focused on child BH treatment, comparing before and after MHPAEA was introduced (Walter et al, 2017). This study used a large private insurance claims database to examine the impact of MHPAEA on mental health outpatient service utilization and annual OOP spending among children who had a mental health diagnosis.…”

Medicaid Expenditures Among Children With Noncomplex Chronic Diseases

“…However, children covered by commercial insurance have also demonstrated an increase in mental health service use since the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008. 18 There is also a risk of misclassification of patient complexity when using the CRG algorithm. Children with NC-CDs often have relapsing and remitting courses and intermittent use of health care.…”

Healthcare Utilization and Morbidity among Adolescents with ADHD in Children Aged 11-17 Years, NHIS, 2017

“…In previous meta-analyses of the available studies, many of the potential studies had to be excluded due to duplications, as well as studies not meeting the inclusion criteria (e.g., case reports, animal studies, or not investigating the desired impact) [16][17][18]. In a large, prospective study of over 2 million US children aged 3-17 years, researchers found that the annual number of visits per child to mental health professionals for behavioral therapy increased between 2007-2009 and 2010-2013 [30]. In very young children with ADHD (aged 3-5 years), it has been reported that there is an increased use of medical services for treatment due to a greater risk of injuries and poisonings resulting from impulsive/overactive behaviors as well as for medical services to provide psychotropic medications as compared with children who do not have ADHD [26].…”