An Evaluation of the Medicare Improvements for Patients and Providers Act of 2008’s Mental Health Parity Provision Among Medicare Beneficiaries with Depression Restricted; Files & ToC
Tetlow, Sonia (Spring 2024)
Abstract
Mental health conditions are common among U.S. populations, including older Americans, yet fewer than half of people with any mental health condition on average receive mental health services. Historically, mental health conditions were treated separately from medical conditions, through different health care systems with unique health insurance coverage and payment requirements. The Medicare Improvements for Patients and Providers Act of 2008 reduced cost-sharing for outpatient mental health services to Medicare beneficiaries from 50% to 20%, creating parity with equivalent outpatient medical care. This dissertation examines the impact of Medicare mental health parity among Medicare beneficiaries with depression.
The first study examines the impact of Medicare mental health parity on use of outpatient mental health services and associated out-of-pocket (OOP) expenditures among Medicare beneficiaries with depression overall and stratified by Medicare type and provider type. Findings indicate that implementation of mental health parity in combination with routine depression screening contributed to significant increases in average use, the proportion of use, and the intensity of use of outpatient mental health services among Medicare beneficiaries with depression. OOP expenditures for outpatient mental health visits increased by a statistically significant but small amount per year after parity.
The second study examines the differential effects of Medicare parity among beneficiaries with depression by diagnoses of comorbid Diabetes Mellitus (DM) and coronary heart disease (CHD) and the impact on expenditures for outpatient mental health and medical care. Findings indicate that Medicare parity had the greatest positive impact among Medicare beneficiaries with all three conditions. Though outpatient mental health service use increased, associated expenditures did not. In contrast, expenditures for outpatient medical services increased significantly during the same time period.
The third study examines whether Medicare parity had a differential impact by race and ethnicity and family income. Findings indicate that parity contributed to significant increases in use of outpatient mental health services among Non-Hispanic White and Hispanic beneficiaries but not among other racial and ethnic minority beneficiaries. Medicare beneficiaries in the lowest and highest income groups experienced the greatest increases in outpatient mental health service use, and OOP expenditures increased significantly among beneficiaries with higher income.
Table of Contents
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