CoChat
Sign Up
Cited by 47Healthcare Policy and ManagementHealth, Medicine and SocietyMental Health Treatment and Access

Equity In Managed Care For Mental Disorders: Benefit parity is not sufficient to ensure equity.

Burnam, M. Audrey, Escarce, José J.·1999·Health Affairs
DOI 10.1377/hlthaff.18.5.22
Open this paper in CoChat — free account

Abstract

PROLOGUE: Jonathan Swift once wrote, “Laws are like cobwebs, which may catch small flies, but let wasps and hornets break through.” Imperfect though they often are, new laws are our primary means of making rules for a changing society. The Mental Health Parity Act was intended to eliminate the disparity between benefits that employers provide for mental health care and benefits they provide for general medical care. But this paper by Audrey Burnam and José Escarce argues that the legislation is too limited to ensure true equity. Equity of benefits is the small fly caught in the cobweb, while inequity of access remains a considerable problem under managed care. According to these authors, legislation must go well beyond benefit design, which has been rendered relatively inconsequential by a system that limits care more than it limits benefits, and look at the safeguards and standards that are in place to ensure appropriate delivery of mental health care. Burnam is a senior behavioral scientist and codirector of the Drug Policy Research Center at RAND, in Santa Monica, California. She has a doctorate in social psychology and has been actively involved in mental health and substance abuse research for more than twenty years. Escarce is a senior natural scientist at RAND, where he is codirector of the Center for Research on Health Care Organization, Economics, and Finance and director of the RAND/University of California, Los Angeles/Harvard Center for Health Care Financing Policy Research. He is also a trained physician. ABSTRACT: Equity of mental health care relative to general medical care is a long-standing policy issue in the mental health field, which in recent years has been debated as an issue of parity in insurance benefits. The shift toward managed mental health care makes the parity debate less controversial, because feared cost increases are an unlikely consequence under managed care. We argue, however, that managed care also makes benefit parity less relevant to the goals of achieving fairness in the delivery of mental health services. A broader policy perspective is required to encompass concerns about fairness under managed care.

Integrity signals

Registry

Crossref · 10.1377/hlthaff.18.5.22

Cites

13 of 13 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A key factor in the passage of the MHPAEA was the belief among policymakers, supported by rigorous academic research, that parity could improve fairness in insurance coverage without dramatically increasing health care expenditures.

    “A key factor in the passage of the MHPAEA was the belief among policymakers, supported by rigorous academic research,20,21 that parity could improve fairness in insurance coverage without dramatically increasing health care expenditures.”

    From Parity and Out-of-Pocket Spending for Children With High Mental Health or Substance Abuse Expenditures (2013) · cites this paper as [20]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Burnam, M. A., & Escarce, J. J.
Affiliations
RAND Corporation (US)
ORCID
Escarce, José J.
Venue
Health Affairs
Publisher
Health Affairs Publishing, LLC
Published
1999-09
Volume
18
Issue
5
Pages
22-31
ISSN
  • 0278-2715 (ISSN-L)
  • 1544-5208
DOI
10.1377/hlthaff.18.5.22
OpenAlex
W2147956019
Cited by
47
References
13
Citations by year
2020: 1 · 2019: 1 · 2018: 1 · 2016: 1 · 2013: 1 · 2012: 1
FWCI
20.43
Type
journal article
Language
en
Open access
closed
Locations
  • Health Affairs (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
National Institute of Mental Health (MH54623, P50MH054623)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
mental health parity, managed care, mental illness, health care equity, access to mental health care, insurance benefits, employer health benefits, mental health policy
MeSH terms
Mental Disorders, Cost Control, Forecasting, Humans, Insurance Benefits, Managed Care Programs, Mental Health Services, Quality Assurance, Health Care, United States, Substance-Related Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review