In Brief

Privately insured consumers are still paying more out of pocket for mental health treatment than they are for other medical visits, even though many states have passed mental health parity mandates, according to a report in the September issue of The Journal of Mental Health Policy and Economics (Vol. 9, No. 3). In addition, the longer people continue treatment for a mental health issue, the less insurance coverage they are likely to receive, compared with long-term coverage for non-mental health treatments, the report finds.

"If you have a family member [on your health insurance policy] who has schizophrenia, and they require hospitalization or intensive treatment, in a lot of insurance plans, that's not going to be covered as generously as if they were in a car accident," says Samuel H. Zuvekas, PhD, one of the study researchers. Thus, high out-of-pocket expenses for mental health treatment may hinder access to these services, particularly for those who need treatments of greater intensity or duration.

Zuvekas and co-author Chad D. Meyerhoefer, PhD, are both economists at the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, a federal agency within the Department of Health and Human Services. They examined data on mental health-care use and expenses from the agency's Medical Expenditure Panel Survey, which identifies specific health services Americans use, how frequently they use them, the cost of these services and how they are paid for, as well as what kinds of government and private health insurance plans are held by and available to American workers.

Zuvekas and Meyerhoefer measured what consumers under the age of 65 with private health insurance coverage (mostly from employers) actually paid out of pocket--as opposed to benefits stated in insurance policy booklets. They found that from 1996 to 2003, out-of-pocket mental health expenses decreased from 39 to 35 percent of the total expense of mental heath-care visits, while nonmental health expenses decreased from 31 to 26 percent.

Their most striking finding, says Zuvekas, and one that is consistent with earlier research, is that out-of-pocket expenses tend to decline as the number of nonmental health visits increases, but out-of-pocket expenses for mental health-related visits increase with the number of visits. Why? The researchers cite several factors. Managed behavioral heath-care organizations' restrictions on the number of covered visits or their requirements to use in-network providers may have led consumers to seek treatment from more costly out-of-network providers or opt out of mental health coverage altogether and pay the full costs themselves. Other consumers with privacy concerns may avoid seeking reimbursement from their insurers.

In addition, employers who self-insure--such as many large corporations--are exempt from state mental health mandates under the 1974 Employee Retirement Income Security Act legislation. "So, even in states where there are strong mental health parity movements, [mental health mandates are] only applied to a limited number of employees, which limits their reach," says Zuvekas.

--E. Packard