Using simulated bill paying and data from MarketScan and an employer health benefit survey, this study examines examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the afford ability of employer-based insurance from 2004 to 2007.  The study finds that health plans covered slightly fewer expenses in 2007 than in 2004 and that out-of-pocket spending grew by more than 33 percent owing largely to growth in overall spending. The study found that the increased costs significantly affected those earning up to 200 percent of the federal poverty level (FPL). 

Gabel, J. R., R. McDevitt, et al. (2009). Trends in underinsurance and the afford ability of employer coverage, 2004-2007. Health Affairs, 28(4), w595-w606. DOI: 10.1377/hlthaff.28.4.w595 http://content.healthaffairs.org/cgi/content/abstract/28/4/w595 

Authors: Jon R. Gabel, Roland McDevitt, Ryan Lore, Jeremy Pickreign, Heidi Whitmore and Tina Ding

This study examined health service access among children of different racial/ethnic groups, finding that, among other results, counseling accessing was lower among non-Latino/a Black children than for non-Latino/a white children.  In addition, both private insurance and lack of insurance were negatively associated with counseling access.  The authors note that both privately insured and uninsured children had less access to needed mental health counseling than did those with public insurance, emphasizing the importance of Medicaid and SCHIP in children's mental health. 

Wells, R., M. M. Hillemeier, et al. (2009). Health service access across racial/ethnic groups of children in the child welfare system. Child Abuse Negl, 33(5), 282-92. http://www.ncbi.nlm.nih.gov/pubmed/19481260 

Authors: Rebecca Wells, Marianne M. Hillemeier, Yu Bai, Rhonda Belue.

This paper addresses the following key questions: (1) How much was spent in the United States to provide M/SU treatment in 2001? (2) How were the expenditures for M/SU distributed by payer and provider type? (3) How did spending change from 1991 to 2001? (4) How did M/SU spending compare with spending for all U.S. health care?

The report finds that public payers began to bear a growing share of spending for mental health and substance abuse treatment. 

Download the full report (PDF): Trends U.S. Spending for Mental Health and Substance Abuse Treatment, 1991-2001 the Decline in Receipt of Substance Abuse Treatment by the Privately Insured, 1992-2001.pdf (117.68 kb)

This report examines trends in employer-based insurance spending for mental health and substance abuse, examining the underlying factors influencing M/SU trends in private insurance by decomposing changes in private insurance between 1992 and 1999 into changes in the probability of use, intensity of use, and cost per service used. 

Download the full report here (PDF): What Drove Trends in Private Insurance Expenditures on Mental Health and Substance Abuse Care, 1992-1999.pdf (92.68 kb)

The goal of this study is to examine underlying trends in substance abuse services that are financed through private insurance. Although other studies have examined how aggregate private health insurance spending on substance abuse treatment has changed, this study looks at that trend in greater depth. It examines the percentage of the population receiving substance abuse services and particular types of services. It examines trends by inpatient, outpatient, and pharmaceutical services in access, intensity of services, and price per unit of service. Moreover, trends in cost sharing are revealed.

Download the full study here (PDF): Trends The Decline in Receipt of Substance Abuse Treatment by the Privately Insured, 1992-2001.pdf (67.06 kb)

The following link provides a selected bibliography of articles and reports examining behavioral health parity through 1999. 

The bibliography is available from SAMHSA here: http://mentalhealth.samhsa.gov/cmhs/ManagedCare/Parity/Bibliography.asp