Tough choices: Children with mental health needs, private health insurance and family out-of-pocket spending
Study Design: Two samples of children were examined: those with mental health needs (n=3,222) and those with autism (n=260) in the Medical Expenditure Panel Survey 2002-2012. Plans available on state health insurance exchanges with generous and restrictive benchmark plans illustrate variation in plans. Regressions estimate the association between plan rating, plan features and service use experiences. Simulations generate ratings, plan-covered and family out-of-pocket expenses for each family-plan pair. Finally, ratings are compared to expenditures.
Principal Findings: A generous state offers 142 plans, 36% of which are ranked high quality. A more restrictive state offers 46 plans, of which 17% are ranked high quality. Families rate plans higher when the plans do not manage care and when they have low rather than high deductibles (≥$2,400). Analyses yield distributions of family ratings and expenditures for each of the 188 plans. Low correlations between the plan-paid proportion of expenditures, plan features and plan ratings identify areas where families need better information.
Conclusions: The proposed study develops firmer evidence about family insurance choice strategies needing improvement. This work is a stepping-stone to future intervention studies focused on improving family insurance choices.
Learning Areas:Social and behavioral sciences
List health insurance plan features associated with positive plan rating among families raising children with mental health needs Describe the variation in plan covered and out-of-pocket expenditures faced by families raising a child with mental health needs in an illustrative set of generous and restrictive plans Identify health insurance plan features that families seem to overlook when rating their satisfaction with their plans
Keyword(s): Health Insurance, Child/Adolescent Mental Health
Qualified on the content I am responsible for because: I have been the principal investigator of several federally funded grants including two PCORI grants focusing on patient-centered outcomes in child mental health. I have published on access to care for children with mental health needs, and I am currently chair of the Mental Health Section of the American Public Health Association.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.