The mental health parity debate continues

Historically, health insurance covered treatment for mental health conditions differently than treatments for physical conditions. Recently, advocates have been supporting mental health parity.

Coverage for mental healthcare had its own cost-sharing structure--more restrictive limits on the number of inpatient days and outpatient visits allowed, separate annual and lifetime caps on coverage, for example--making mental health benefits substantially less generous than benefits for physical health conditions, notes a new policy brief published in Health Affairs.

Here are the four main obstacles facing the implementation of mental health parity outlined in the paper:

1. Inadequate access to mental health and substance abuse care

Mental health professionals tend to concentrate in high-income, high-populated areas, while a lack of mental health providers exists in rural areas, notes the policy brief. Substance abuse treatment rates rose when states enacted parity legislation preventing payers from limiting substance abuse coverage more than they do for other conditions, FierceHealthPayer previously reported.  To increase access for all those in need of mental health and substance abuse care, high-quality providers must be available.

2. No equivalent services

The on-going debate continues between mental health/substance use benefits and medical/surgical benefits. Many treatments for mental health disorders do not have an equivalent medical treatment. Full parity requires consistency across mental health/substance use and medical/surgical treatments, according to the policy brief.

3. Fragmentation of the healthcare delivery system

One of the many challenges facing group health plans is the integration of mental health and substance use care with medical care despite using separate administrators. Many people with mental health issues have co-occurring physical disorders, while those with medical conditions may be prone to mental disorders. This creates a need for coordination to decrease fragmentation, reports the brief.

4. Not everyone is subject to parity

Although the Mental Health Parity and Addiction Equity Act has been in place since 2008, many questions remain regarding how it affects insurers and whether they cover psychiatric care. Many plans and benefits are not required to provide equivalent coverage under the new Affordable Care Act law, including some fee-for-service Medicaid options, employers with fewer than 50 employees who self-insure, and self-funded nonfederal governmental health plans that opt out.

For more:
- check out the Health Affairs policy brief