A test of mental health parity: comparisons of outcomes of hospital concurrent utilization review.
The Mental Health Parity Act of 1996 had as its goal the equity of coverage of mental health care and physical health care. The purpose of this study was to examine the outcomes of hospital concurrent utilization review as a measure of the progress toward the equity goal. The study examined 4 years of denials of certification for reimbursement by payers of inpatient care (1998-2001). Psychiatry was first compared to clinical services with a like number of annual admissions and then compared to clinical services with a like number of concurrent reviews. For each year, psychiatry had the highest numbers of cases denied and patient days denied. The most frequent reason for a psychiatric denial was that the inpatient benefit level had been exceeded. There was only one instance, in 4 years, when this reason (benefit limit exceeded) was given for a patient with a physical illness. This study provides evidence of the current inequity of reimbursement for treatment of mental illness.
Murray
Mary Ellen
ME
School of Nursing, University of Wisconsin - Madison, K6/340 Clinical Science Center, 600 Highland Ave, 53792, USA. memurra1@wisc.edu
Henriques
Jeffrey B
JB
D006760:Hospitalization / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008605:Mental Health Services; D014600:Utilization Review / Q000706:statistics & numerical data*