This white paper by Milliman Inc. analyzes the Mental Health Parity and Addiction Equity Act of 2008, focusing on effects of the parity legislation on individuals, health care plans, managed behavioral health care organizations (MHBOs) and other key stakeholders. 

Download the white paper from Milliman: http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/preparing-parity-investing-mental-WP05-01-09.pdf 

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 study examines the prevalence of medical and psychiatric conditions among substance abuse patients and demographically matched controls from the same HMO, finding "approximately one third of the conditions examined were more common among substance abuse patients than among matched controls, and many of these conditions were among the most costly. We also found that pain-related diagnoses, including arthritis, headache, and lower back pain, were more prevalent among such patients, particularly those dependent on narcotic analgesics."  In addition, the authors conclude that the findings "point to the importance of examining comorbid medical conditions and substance abuse in both primary and specialty care. Our findings regarding pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of an underlying substance abuse disorder."

Mertens, J., Yun, L., Sujaya, P., Moore, C., & Weisner, C. (2003). Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison to matched controls. Archives of Internal Medicine, 163(20), 2511-2517.  http://archinte.ama-assn.org/cgi/content/abstract/163/20/2511 

Authors:  Jennifer R. Mertens, Yun W. Lu, Sujaya Parthasarathy, Charles Moore, Constance M. Weisner.   

This study examined drug and alcohol users without diagnosed substance abuse disorders within the context of HMO primary care.  The authors found "a prevalence of 7.5% for hazardous drinking and 3.2% for drug use in primary care (10% had at least one of the two problems). Hazardous drinkers and drug users had heightened prevalences for eight medical conditions, including costly conditions such as injury and hypertension, and psychiatric conditions. Medical costs for the year examined were not higher, except for those who also had psychiatric conditions".  They study concludes that "the prevalence of hazardous drinking and drug use was similar to hypertension and diabetes. Hazardous drinkers and drug users' heightened medical conditions, especially those related to alcohol and drug abuse, indicate that screening and brief intervention at this lower threshold of hazardous drinking and drug use will detect individuals with health risks sooner. Optimal treatment and prevention of some medical disorders may require identification and intervention of underlying hazardous alcohol or drug use."

Mertens, J. R., Weisner, C., Ray, G. T., Fireman, B., & Walsh, K. (2005). Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs. Alcohol Clin Exp Res, 29(6), 989-998. http://www.alcoholism-cer.com/pt/re/alcoholism/abstract.00000374-200506000-00009onclick= 

Authors: Jennifer R. Mertens, Constance Weisner, Thomas G. Ray, Bruce Fireman, Kevin Walsh.

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)