title: Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures.
abstract: OBJECTIVE
  The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act required health plans to provide mental health and substance use disorder (MH/SUD) benefits on par with medical benefits beginning in 2010. Previous research found that parity significantly lowered average out-of-pocket (OOP) spending on MH/SUD treatment of children. No evidence is available on how parity affects OOP spending by families of children with the highest MH/SUD treatment expenditures.
  
  
  METHODS
  We used a difference-in-differences study design to examine whether parity reduced families' (1) share of total MH/SUD treatment expenditures paid OOP or (2) average OOP spending among children whose total MH/SUD expenditures met or exceeded the 90th percentile. By using claims data, we compared changes 2 years before (1999-2000) and 2 years after (2001-2002) the Federal Employees Health Benefits Program implemented parity to a contemporaneous group of health plans that did not implement parity over the same 4-year period. We examined those enrolled in the Federal Employees Health Benefits Program because their parity directive is similar to and served as a model for the new federal parity law.
  
  
  RESULTS
  Parity led to statistically significant annual declines in the share of total MH/SUD treatment expenditures paid OOP (-5%, 95% confidence interval: -6% to -4%) and average OOP spending on MH/SUD treatment (-$178, 95% confidence interval: -257 to -97).
  
  
  CONCLUSIONS
  This study provides the first empirical evidence that parity reduces the share and level of OOP spending by families of children with the highest MH/SUD treatment expenditures; however, these spending reductions were smaller than anticipated and unlikely to meaningfully improve families' financial protection.
authors: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cbarry@jhsph.edu
authors: Colleen L
authors: CL
authors: Barry
authors: Alyna T
authors: AT
authors: Chien
authors: Sharon-Lise T
authors: SL
authors: Normand
authors: Alisa B
authors: AB
authors: Busch
authors: Vanessa
authors: V
authors: Azzone
authors: Howard H
authors: HH
authors: Goldman
authors: Haiden A
authors: HA
authors: Huskamp
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures / Q000331:legislation & jurisprudence / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008603:Mental Health / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D008605:Mental Health Services / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D019966:Substance-Related Disorders / Q000191:economics* / Q000628:therapy; D055815:Young Adult