Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans

Pediatrics. 2017 May;139(Suppl 2):S127-S135. doi: 10.1542/peds.2016-2786G.

Abstract

Background and objectives: Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services.

Methods: Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used.

Results: Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs.

Conclusions: Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans.

MeSH terms

  • Adolescent
  • Behavior Therapy
  • Child
  • Child, Preschool
  • Deductibles and Coinsurance
  • Female
  • Health Benefit Plans, Employee / economics*
  • Health Expenditures*
  • Humans
  • Male
  • Mental Health Services / statistics & numerical data*
  • Neurodevelopmental Disorders / epidemiology
  • Neurodevelopmental Disorders / therapy*
  • United States