Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Haiden A. Huskamp, PhD¹, Howard H. Goldman, MD, PhD², Richard G. Frank, PhD¹, M. Audrey Burnam, PhD³, M. Susan Ridgely, JD³, Colleen L. Barry, PhD⁴, Vanessa Azzone, PhD¹, and Alisa B. Busch, MD⁵. (1) Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, (2) Department of Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, 310-983-1671, hh.goldman@verizon.net, (3) The RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, (4) Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street #302, New Haven, CT 06520, (5) McLean Hospital Alcohol and Drug Abuse Treatment Program, Harvard Medical School, Proctor Building, 115 Mill Street, Belmont, MA 02478

We used a quasi-experimental design where the FEHB experience before and after the parity policy was compared to a matched set of private insurance comparison plans. We used archival health plan enrollment and claims/encounter data from nine large plans from the FEHB for the period 1999-2002 (2 years before and 2 years after parity implementation). Using a difference-in-differences approach, we estimated logistic regression models of the probability of MH/SA service use and generalized linear models of MH/SA spending conditional on use for the nine FEHB plans and a matched set of non-FEHB comparison plans. For adults, only one of the nine plans had a significant post-parity increase in the probability of MH/SA use after taking into account secular trends. The estimated probability of use for the remaining eight plans was either not significantly different from zero or was negative and significant. The difference-in-differences analysis for total spending showed a decline in annual MH/SA expenditures in seven of the nine plans; four of these differences were statistically significant. The other two plans showed non-significant increases. The estimate of the effect on MH/SA out-of-pocket spending for adults showed a significant decline in out-of-pocket spending for five plans and a non-significant decline for a sixth plan. Out-of-pocket spending increased in three plans. The results for use and spending for children parallel those for adults. Overall, the parity policy was implemented with little or no significant increases in rate of MH/SA use or spending, while providing MH/SA users improved financial protection in many instances.

Learning Objectives:

• Recognize the strengths and limitations of a quasi-experimental design used to evaluate a natural experiment
• Describe the impact of parity on utilization and costs
• Analyze the generalizability of the findings for federal health policy

Keywords: Mental Health, Substance Abuse

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation