Many economic and health care policy changes have gone into effect since 2009 that shape insurance payments for the treatment of mental health and substance use disorders.
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However, the most recent report on historical data cover the period of 1986-2009 and many economic and healthcare policy changes have occurred since then including those related to the 2007–09 recession, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the Medicare Improvements for Patients and Providers Act of 2008, and the Affordable Care Act.
Many of these policies were designed to prevent insurance companies from providing benefit limitations on mental health and substance use services.
This study fills the knowledge gap between 2009-2014 and provides an empirical basis for future decision making on mental health and substance use disorder treatments.
This study analyzed multiple national databases to obtain estimates for spending on mental health and substance use disorders, percent of the population utilizing mental health and substance use disorder treatment, and prescription fills for substance use disorder. Spending estimates were calculated by identifying primary diagnosis from the International Classification of diseases, Ninth Revision, Clinical Modification (IDC-9-CM) in the following six databases: SAMHSA Behavioral Health Expenditure and Use Accounts, National Health Expenditure Accounts, National Ambulatory Medical Care Survey, Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP), Medical Expenditure Panel Survey (MEPS), and Economic Census Service Annual Survey.
To understand drivers of the trends in behavioral health spending (e.g., such as the percent of the population utilizing treatment) they used the SAMHSA National Survey on Drug Use and Health as their primary dataset and incorporated the Medical Expenditure Panel Survey (MEPS), and Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP). In order to estimate the number of prescription fill medications used to treat substance use disorder, they analyzed data from the National Prescription Audit of the IMS Institute for Healthcare Informatics.
For mental health, an important trend in financing (e.g., source of payment) is the shift from a system in which the majority of funding came from state and local governments or individuals’ out-of-pocket spending (with some limited federal block grant financing) to a system that is financed largely by Medicaid, Medicare, and private insurance.
The shift to insurance-based financing of treatment has been slower for substance use disorders than for mental health. Specifically, mental health spending from insurance (i.e., Medicaid, Medicare, and private insurance) increased from 44% in 1986 to 68% in 2014. In contrast, substance use disorder spending from insurance was 45% in 1986 and 46% in 2014.
This study highlights the differences in funding sources for mental health treatment versus substance use disorders. Funding for the treatment of substance use disorders has not shifted into an insurance-based system to the same degree as mental health treatment.
The authors speculate two reasons for the findings:
As explained by the authors, a report on health account spending should be used to help determine how spending on care for mental health or substance use disorder treatments, and utilization, relate to population health. Future research should seek to integrate all these elements, at this time, a cohesive database of this nature does not exist.
Mark, T. L., Yee, T., Levit, K. R., Camacho-Cook, J., Cutler, E., Carroll, C. D. (2016). Insurance financing increased for mental health conditions but not for substance use disorders, 1986-2014. Health Affairs, 35(6), 958-965.
l
However, the most recent report on historical data cover the period of 1986-2009 and many economic and healthcare policy changes have occurred since then including those related to the 2007–09 recession, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the Medicare Improvements for Patients and Providers Act of 2008, and the Affordable Care Act.
Many of these policies were designed to prevent insurance companies from providing benefit limitations on mental health and substance use services.
This study fills the knowledge gap between 2009-2014 and provides an empirical basis for future decision making on mental health and substance use disorder treatments.
This study analyzed multiple national databases to obtain estimates for spending on mental health and substance use disorders, percent of the population utilizing mental health and substance use disorder treatment, and prescription fills for substance use disorder. Spending estimates were calculated by identifying primary diagnosis from the International Classification of diseases, Ninth Revision, Clinical Modification (IDC-9-CM) in the following six databases: SAMHSA Behavioral Health Expenditure and Use Accounts, National Health Expenditure Accounts, National Ambulatory Medical Care Survey, Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP), Medical Expenditure Panel Survey (MEPS), and Economic Census Service Annual Survey.
To understand drivers of the trends in behavioral health spending (e.g., such as the percent of the population utilizing treatment) they used the SAMHSA National Survey on Drug Use and Health as their primary dataset and incorporated the Medical Expenditure Panel Survey (MEPS), and Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP). In order to estimate the number of prescription fill medications used to treat substance use disorder, they analyzed data from the National Prescription Audit of the IMS Institute for Healthcare Informatics.
For mental health, an important trend in financing (e.g., source of payment) is the shift from a system in which the majority of funding came from state and local governments or individuals’ out-of-pocket spending (with some limited federal block grant financing) to a system that is financed largely by Medicaid, Medicare, and private insurance.
The shift to insurance-based financing of treatment has been slower for substance use disorders than for mental health. Specifically, mental health spending from insurance (i.e., Medicaid, Medicare, and private insurance) increased from 44% in 1986 to 68% in 2014. In contrast, substance use disorder spending from insurance was 45% in 1986 and 46% in 2014.
This study highlights the differences in funding sources for mental health treatment versus substance use disorders. Funding for the treatment of substance use disorders has not shifted into an insurance-based system to the same degree as mental health treatment.
The authors speculate two reasons for the findings:
As explained by the authors, a report on health account spending should be used to help determine how spending on care for mental health or substance use disorder treatments, and utilization, relate to population health. Future research should seek to integrate all these elements, at this time, a cohesive database of this nature does not exist.
Mark, T. L., Yee, T., Levit, K. R., Camacho-Cook, J., Cutler, E., Carroll, C. D. (2016). Insurance financing increased for mental health conditions but not for substance use disorders, 1986-2014. Health Affairs, 35(6), 958-965.
l
However, the most recent report on historical data cover the period of 1986-2009 and many economic and healthcare policy changes have occurred since then including those related to the 2007–09 recession, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the Medicare Improvements for Patients and Providers Act of 2008, and the Affordable Care Act.
Many of these policies were designed to prevent insurance companies from providing benefit limitations on mental health and substance use services.
This study fills the knowledge gap between 2009-2014 and provides an empirical basis for future decision making on mental health and substance use disorder treatments.
This study analyzed multiple national databases to obtain estimates for spending on mental health and substance use disorders, percent of the population utilizing mental health and substance use disorder treatment, and prescription fills for substance use disorder. Spending estimates were calculated by identifying primary diagnosis from the International Classification of diseases, Ninth Revision, Clinical Modification (IDC-9-CM) in the following six databases: SAMHSA Behavioral Health Expenditure and Use Accounts, National Health Expenditure Accounts, National Ambulatory Medical Care Survey, Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP), Medical Expenditure Panel Survey (MEPS), and Economic Census Service Annual Survey.
To understand drivers of the trends in behavioral health spending (e.g., such as the percent of the population utilizing treatment) they used the SAMHSA National Survey on Drug Use and Health as their primary dataset and incorporated the Medical Expenditure Panel Survey (MEPS), and Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP). In order to estimate the number of prescription fill medications used to treat substance use disorder, they analyzed data from the National Prescription Audit of the IMS Institute for Healthcare Informatics.
For mental health, an important trend in financing (e.g., source of payment) is the shift from a system in which the majority of funding came from state and local governments or individuals’ out-of-pocket spending (with some limited federal block grant financing) to a system that is financed largely by Medicaid, Medicare, and private insurance.
The shift to insurance-based financing of treatment has been slower for substance use disorders than for mental health. Specifically, mental health spending from insurance (i.e., Medicaid, Medicare, and private insurance) increased from 44% in 1986 to 68% in 2014. In contrast, substance use disorder spending from insurance was 45% in 1986 and 46% in 2014.
This study highlights the differences in funding sources for mental health treatment versus substance use disorders. Funding for the treatment of substance use disorders has not shifted into an insurance-based system to the same degree as mental health treatment.
The authors speculate two reasons for the findings:
As explained by the authors, a report on health account spending should be used to help determine how spending on care for mental health or substance use disorder treatments, and utilization, relate to population health. Future research should seek to integrate all these elements, at this time, a cohesive database of this nature does not exist.
Mark, T. L., Yee, T., Levit, K. R., Camacho-Cook, J., Cutler, E., Carroll, C. D. (2016). Insurance financing increased for mental health conditions but not for substance use disorders, 1986-2014. Health Affairs, 35(6), 958-965.
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