“The fact that we did not observe such an increase [in family out-of-pocket spending] suggests that the federal parity law might have conferred financial protection to families seeking to avail themselves of treatments now covered more generously under the law—a central intent of its architects,” Elizabeth A. Stuart, Ph.D., of Johns Hopkins Bloomberg School of Public Health and colleagues wrote.
For the study, Stuart and colleagues analyzed health insurance commercial group claims data on children 18 and under with autism from 2007 to 2012. The researchers compared the use of mental health care, speech and language therapy, and occupational or physical therapy; the quantity of services used among service users; total spending (insurer plus out of pocket) among service users; and out-of-pocket spending among service users before and after the implementation of the Mental Health Parity and Addiction Equity Act, which went into effect in 2010.
Stuart and colleagues found that the law’s implementation was associated with a modest increase in the use of health care services among children with autism spectrum disorder. “[O]ver the first year following parity, this translated into 1.6 additional mental health visits per user of mental health services, 0.4 additional speech and language therapy visits per user of speech and language therapy, and 0.7 additional occupational and physical therapy visits per user of occupational and physical therapies,” they wrote. Although there were small but significant increases in trends for total health care spending during the first year following the implementation of the parity law, “the increase in total spending was not accompanied by an increase in out-of-pocket spending by families,” they added.
The authors concluded, “This study provides evidence that the federal parity law was associated with greater use of services paid for through insurance for children with ASD without driving up the out-of-pocket spending paid by families through their insurance policies. However, the higher rates of use after the implementation of the law are still well below what one might expect in the context of increasing levels of impairment and service needs over the past few years … Our findings suggest that more stringent parity enforcement, additional policy approaches, or both, might be needed to ensure that children with ASD are connected to evidence-based services and supports.”
For related information, see the Psychiatric News article “Insurers Found to Be Complying With Certain Parts of Parity Law” and the Psychiatric Services article “The Impact of Insurance Coverage Types on Access to and Utilization of Health Services for U.S. Children With Autism.”