Do We Really Want Mental Health Parity?
The final rules are out and it seems that the quest for mental health parity has been wholly successful. I’m convinced that almost no one understands what it means (see our previous post). Nonetheless, everyone is cheering.
Everyone that is, except for a few of us here at the NCPA. This is from a Health Alert I wrote six years ago:
He
re’s the question: Would you want an insurance plan that had the same deductible and co-payment for every procedure? Need time to think about that? Then try this: Does it make sense to have the same deductibles and co-payments for chiropractic therapy as for setting a broken leg? Or from the mental health field, should the payment terms that cover bipolar disorder be the same as those that apply to marriage counseling (required coverage in some states)? Should pastoral counseling (also required in some places) be reimbursed the same way as coverage for schizophrenia? If you have any sense, the answers are: No, No, No and No.
One way to keep insurance costs down is through incentives. Patients should pay more of their bill when they exercise discretion and especially where patient discretion is appropriate. In mental health, this principle applies in spades because:
- the illness is often experienced subjectively,
- there are often no objective standards for diagnosis or treatment,
- doctors often exercise enormous discretion,
- patients also exercise a lot of discretion and
- patient cooperation is often crucial to any cure.
Unlike fixing a broken leg, these are precisely the conditions that make patient cost sharing highly desirable.
If I haven’t convinced you so far, consider this National Bureau of Economic Research study finding: 38 percent of all mental health patients ― representing 28 percent of all treatment visits ― are people who do not have any mental health disorder.
The NCPA has published three short analyses (here, here and here) that describe in more detail the case against mental health parity.
This is a more thorough discussion of the point that I was trying to make on the previous blog post.
Maybe you should write a blog post or two.
Dr. Goodman has good continuity.
Mental health is tricky, especially with how little is known about it. This change will add a lot of unnecessary cost.
And a lot of unnecessary strain on the system.
Which makes costs go even higher.
“the illness is often experienced subjectively,”
This is the biggest cost-factor to me. It’s not like an infection which is either there or not.
Right. Especially because the genesis of many mental health problems is still unknown.
More money for research into these areas would not be wasted.
“the illness is often experienced subjectively,”
This is tricky. I can imagine situations where this makes treatment incredibly difficult or places the doctor in an ethical dilemma.
I just wish our doctors were more inclined to actually think about those dilemmas rather than defer to an administrator or abdicate responsibility.
Agreed. Doctors today are too wiling to say, “Well the patient wants it” as an excuse for not taking responsibility.
“patient cooperation is often crucial to any cure.”
Which makes most mental health problems nearly impossible to treat in that the law has made it so difficult to give people what they direly need without their direct consent.
Not without good reason though. We can’t go back to the days where you could get rid of an annoying family member by having them declared insane.
Of course not, but a middle ground has to be found.
Right. People need help, but we can’t loose the laws so much that healthy people are mistreated.
I think the rational is that poor mental health has big internal irked and externalities so it should be heavily subsidized.
Instead of subsidizing it they set price controls which are just as good if there isn’t going to be a shortage, though I would guess there will be.
I agree the harder we make it to access treatment to these subjective Mental Health treatments and patients the more mass killings we will get to watch on TV.
Pass me the Popcorn…
I wrote a critical article when the law passed in 2008, making similar points (http://tinyurl.com/45k2b9t).
My article quotes the US DOJ: “For mandates to improve the efficiency of the health insurance market, state and federal legislators must be able to identify services the insurance market is not currently covering, for which consumers are willing to pay marginal costs. This task is challenging under the best of circumstances – and benefits are not mandated under the best of circumstances.”
In general, co-payments and deductibles should be tailored to the disease state, not the amount of time the earth takes to revolve around the sun. If we are to succeed in reforms that give us access to health-status insurance, these mandates will have to go, because insurers will no longer be general health insurers, but specialize in diseases.