Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services
Open accessAbstract
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in individual states, the law extends parity to out-of-network services. We conducted an interrupted time-series analysis using insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that extending parity to out-of-network services would broaden access to substance use disorder care obtained outside of plan networks.
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McGinty et al.'s focus on out-of-network care overlooks in-network care, which likely accounts for the majority of mental health and SUD treatment.
“Although this study highlights a notable effect of MHPAEA, its focus on out-of-network care overlooks in-network care, which likely accounts for the majority of MH and SUD treatment.”
From The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders (2017) · cites this paper as McGinty et al., 2015
The Study Data and Methods (Measures; page unavailable) defines the study’s outcomes around out-of-network substance use disorder care, so the criticism of its focus is supported. The Discussion (page unavailable) reports that 23% of inpatient users and 17% of outpatient users had at least one out-of-network service in 2012, consistent with most users having none. It does not establish what share of treatment was in-network, particularly for mental health care. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMcGinty et al. (2015) found that MHPAEA was associated with increased access to, use of, and total spending on out-of-network SUD services between 2007 and 2012.
“McGinty et al. (2015) found that MHPAEA was associated with increased access to, use of, and total spending on out-of-network SUD services between 2007 and 2012.”
From The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders (2017) · cites this paper as McGinty et al., 2015
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“McGinty et al. (2015) found that MHPAEA was associated with increased access to, use of, and total spending on out-of-network SUD services between 2007 and 2012.”
Background
- Authors
- McGinty, E. E., Busch, S. H., Stuart, E. A., Huskamp, H. A., Gibson, T. B., Goldman, H. H., & Barry, C. L.
- Affiliations
- Johns Hopkins University (US)
- Yale University (US)
- Harvard University (US)
- University of Maryland, Baltimore (US)
- ORCID
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2015-08
- Volume
- 34
- Issue
- 8
- Pages
- 1331-1339
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC4607035
- OpenAlex
- W2218775139
- Cited by
- 79
- References
- 23
- Citations by year
- 2026: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 6 · 2019: 7 · 2018: 5 · 2017: 47 · 2016: 5
- FWCI
- 45.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH093414)
- National Institute on Drug Abuse (R01DA026414)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- mental health parity, addiction treatment, self-insured employers, treatment utilization
- MeSH terms
- Health Policy, Humans, Insurance Benefits, Insurance, Health, Mental Health Services, United States, Outcome Assessment, Health Care, Insurance Coverage, Substance-Related Disorders, Healthcare Disparities
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