title: Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits Program.
abstract: OBJECTIVE
  The Federal Employees Health Benefits Program implemented full mental health and substance abuse parity in January 2001. Evaluation of this policy revealed that parity increased adult beneficiaries' financial protection by lowering mental health and substance abuse out-of-pocket costs for service users in most plans studied but did not increase rates of service use or spending among adult service users. This study examined the effects of full mental health and substance abuse parity for children.
  
  
  METHODS
  Employing a quasiexperimental design, we compared children in 7 Federal Employees Health Benefits plans from 1999 to 2002 with children in a matched set of plans that did not have a comparable change in mental health and substance abuse coverage. Using a difference-in-differences analysis, we examined the likelihood of child mental health and substance abuse service use, total spending among child service users, and out-of-pocket spending.
  
  
  RESULTS
  The apparent increase in the rate of children's mental health and substance abuse service use after implementation of parity was almost entirely due to secular trends of increased service utilization. Estimates for children's mental health and substance abuse spending conditional on this service use showed significant decreases in spending per user attributable to parity for 2 plans; spending estimates for the other plans were not statistically significant. Children using these services in 3 of 7 plans experienced statistically significant reductions in out-of-pocket spending attributable to the parity policy, and the average dollar savings was sizeable for users in those 3 plans. In the remaining 4 plans, out-of-pocket spending also decreased, but these decreases were not statistically significant.
  
  
  CONCLUSIONS
  Full mental health and substance abuse parity for children, within the context of managed care, can achieve equivalence of benefits in health insurance coverage and improve financial protection without adversely affecting health care costs but may not expand access for children who need these services.
authors.affiliation: Westat, 1650 Research Blvd, Rockville, MD 20850, USA. susanazrin@westat.com
authors.forename: Susan T
authors.initials: ST
authors.lastname: Azrin
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.forename: Vanessa
authors.initials: V
authors.lastname: Azzone
authors.forename: Howard H
authors.initials: HH
authors.lastname: Goldman
authors.forename: Richard G
authors.initials: RG
authors.lastname: Frank
authors.forename: M Audrey
authors.initials: MA
authors.lastname: Burnam
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: M Susan
authors.initials: MS
authors.lastname: Ridgely
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Busch
authors.forename: Garrett
authors.initials: G
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009310:National Health Insurance, United States; D019966:Substance-Related Disorders; D014481:United States