Mental health benefit limits and cost sharing under managed care: a national survey of employers.
Mental health services experts suggest that managed care diminishes the need for arbitrary benefit limits and consumer cost-sharing. Data from 577 health plans were used to test the hypotheses that health maintenance organizations (HMOs) and carve-out plans are less likely to use benefit limits or service exclusions, have more generous limits, and have lower cost-sharing requirements than non-HMOs and non-carve-out plans. The results show that HMOs were more likely to use service exclusions and did not make less use of benefit limits. Carve-outs were less likely to use some coverage exclusions. Comparisons of the stringency of limits and cost-sharing provisions did not show consistent differences.
Salkever
D S
DS
Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205, USA. dsalkeve@jhsph.edu
Shinogle
J
J
Goldman
H
H
D017047:Cost Sharing; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000458:organization & administration; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007358:Insurance, Psychiatric / Q000191:economics*; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D001523:Mental Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy; D014481:United States