title: Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer.
abstract: OBJECTIVE
  This study evaluated utilization of mental health and substance use services among enrollees at a large employee health plan following changes to benefit limits after passage in 2008 of federal mental health parity legislation.
  
  
  METHODS
  This study used a pre-post design. Benefits and claims data for 43,855 enrollees in the health plan in 2009 and 2010 were analyzed for utilization and costs after removal of a 30-visit cap on the number of covered mental health visits.
  
  
  RESULTS
  There was a large increase in the proportion of health plan enrollees with more than 30 outpatient visits after the cap's removal, an increase of 255% among subscribers and 176% among dependents (p<.001). The number of people near the 30-visit limit for substance use disorders was too few to observe an effect.
  
  
  CONCLUSIONS
  Federal mental health parity legislation is likely to increase utilization of mental health services by individuals who had previously met their benefit limit.
authors.affiliation: The authors are with the Department of Health Management and Policy, University of Michigan, Ann Arbor, where Dr. Grazier is also with the Department of Psychiatry (e-mail: kgrazier@umich.edu ).
authors.forename: Kyle L
authors.initials: KL
authors.lastname: Grazier
authors.affiliation: The authors are with the Department of Health Management and Policy, University of Michigan, Ann Arbor, where Dr. Grazier is also with the Department of Psychiatry (e-mail: kgrazier@umich.edu ).
authors.forename: Daniel
authors.initials: D
authors.lastname: Eisenberg
authors.affiliation: The authors are with the Department of Health Management and Policy, University of Michigan, Ann Arbor, where Dr. Grazier is also with the Department of Psychiatry (e-mail: kgrazier@umich.edu ).
authors.forename: Jenefer M
authors.initials: JM
authors.lastname: Jedele
authors.affiliation: The authors are with the Department of Health Management and Policy, University of Michigan, Ann Arbor, where Dr. Grazier is also with the Department of Psychiatry (e-mail: kgrazier@umich.edu ).
authors.forename: Mary L
authors.initials: ML
authors.lastname: Smiley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006264:Health Benefit Plans, Employee / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008875:Middle Aged; D055815:Young Adult