Trends in insurance coverage and out-of-pocket payments for mental health and substance abuse services: An examination of MEPS data, 1996-2004

In this study, nine years of data from the Medical Expenditure Panel Survey were pooled for an examination of trends in insurance and patient out-of-pocket (OOP) payments for MH/SA outpatient services to privately insured individuals. The analytic sample (n=43,499) were office-based and outpatient MH/SA visits. The outcomes of interest are: 1) percent of visit expenditures paid by private insurance; 2) percent of visit expenditures paid by patient OOP; and 3) private insurance payment (yes/no) on the visit. The primary independent variable is time (month of the visit), with covariates for type of provider and type of disorder treated. Preliminary results: In a linear regression (accounting for complex survey sampling), the percent of per-visit expenditures from patient OOP payments decreased over the study period, but short of statistical significance (p= .065). (In contrast, in the complete MEPS sample of all outpatient visits, the decrease in OOP was statistically significant (p=0.000)). When the provider covariate was added, to evaluate psychiatrists compared to other MD providers of MH/SA visits, the level of significance from the time variable diminished (p=0.461), and the effect of the psychiatrist provider type increased patient OOP, but not at a statistically significant level (p=0.624). A similar effect was observed when psychologists were compared to other non-MD providers. The findings from this study may inform the debate regarding whether mental health parity has resulted in more favorable reimbursement, and whether specialty mental health providers are participating in health plans.