A new study by the School of Public Health published in Psychiatric Services shows people are not using more mental health care after a U.S. law intended to improve employer-sponsored mental health insurance coverage went into effect.
The study, co-authored by Associate Professor Ezra Golberstein and led by graduate and University of Pittsburgh Assistant Professor Coleman Drake (PhD ’18), evaluated the influence of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 on the use of outpatient and clinic-based mental health services and spending.
“Prior to 2008, many employer-sponsored health insurance plans offered mental health coverage that was not equal to the coverage people received for other medical services,” says Drake. “In response, some states enacted mental health care parity laws, but some didn’t. The Mental Health Parity Act of 2008 was an effort to change that across the country and ensure medical and mental health services were covered equally.”
To learn more about the effects of the act, the researchers reviewed data from 2005-2013 provided by the Medical Expenditure Panel Survey, a national survey completed by thousands of households that includes questions about mental health status and mental health services use.
“We found that the federal parity law was not significantly associated with changes in mental health services use, such as the quantity used or total out of pocket spending,” says Drake.
One change the researchers did identify was a shift toward more use of specialty mental health providers rather than primary care providers among people who did seek mental health care.
“If we’re not seeing big changes after the MHPAEA, that could mean one of a few things,” says Drake. “We might not be seeing an increase in mental health services use and spending after the act went into effect because many employer-sponsored health plans were already offering mental health coverage meeting MHPAEA parity standards. Or, it might be that insurers are not complying with the law and increasing their mental health coverage to parity with medical care, meaning the coverage was non-compliant and stayed that way.”
Drake added that the State of New York and others have investigated and reached settlements with insurers for offering poor mental health coverage since the law went into effect, suggesting that non-compliance with the act is a problem and the potential reason for why people aren’t seeking more care.
Based on the findings, Drake recommends that researchers look deeper into the potential issue of insurers not complying with the law. Drake and Golberstein are continuing their research as well, now focusing on differences in treatment among patients that see specialty mental health providers, such as psychiatrists, and primary care providers.