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Health insurance coverage for mental health specialists is still lower than for other medical visits

Consumers have long faced high out-of-pocket costs for mental health and substance abuse treatment in private health insurance plans, as well as limits on the amount of treatment covered. Despite passage of Federal and State mental health parity mandates and voluntarily improved coverage by employers, expenses for outpatient mental health visits, especially to psychiatrists and other specialists, remain less well covered than other medical visits, according to a new study by researchers at the Agency for Healthcare Research and Quality.

Samuel H. Zuvekas, Ph.D., and Chad D. Meyerhoefer, Ph.D., found that out-of-pocket expenses generally declined over the 1996-2003 period, from 39 to 35 percent of total expenses for outpatient mental health visits and from 31 to 26 percent for non-mental health outpatient visits. However, the ratio of out-of-pocket costs was still significantly higher for mental health care. For the first five visits in a year, out-of-pocket costs for ambulatory mental health and non-mental health visits were similar. But from the sixth visit onwards, average out-of-pocket costs for non-mental health visits declined, while those for mental health visits remained the same. However, out-of-pocket costs for mental health visits increased as the number of visits approached and surpassed 20. In addition, out-of-pocket expenses for visits to mental health specialists such as psychiatrists were higher compared with nonspecialists.

Continued high out-of-pocket expenses for mental health care may impede access to mental health treatment, especially for those who need greater treatment intensity, suggest the researchers. Their findings were based on analysis of data on health care use and expenses in 1996 and 2003 from the nationally representative Medical Expenditure Panel Survey.

More details are in "Coverage for mental health treatment: Do the gaps still persist?" by Drs. Zuvekas and Meyerhoefer, in the Journal of Mental Health Policy and Economics 9, pp. 123-131, 2006. Reprints (AHRQ Publication No. 06-R058) are available from the AHRQ Publications Clearinghouse.

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