Mental Health Coverage Woes Not All in Mind

Ninety-eight percent of workers with employer-sponsored health insurance had some sort of mental health coverage in 2002, according to a new study.

"Design of Mental Health Benefits: Still Unequal After All These Years," published in the September/October issue of Health Affairs, finds little variation in the proportion of covered workers offered mental health insurance by plan type, industry, region of the country, or earnings level.

The percentage of workers offered inpatient mental health coverage increased from 87 in 1991 to 96 in 2002. The percentage of workers offered outpatient services increased from 86 in 1991 to 98 in 2002.

That would be encouraging news for everyone if the yardstick used to measure the scope of mental health benefits were what was done in the past. However, the yardstick used is what services are offered for physical health conditions.

As the study's title suggests, the authors find that mental health parity laws have not really put access to mental health services on a par with access to other services, thanks to continued limits on outpatient and inpatient visits.

"Health plans have tended to require higher copayments and more stringent limits on inpatient hospital days and outpatient visits for behavioral health treatment," the authors say. "Plans have also limited mental health coverage through the use of annual and lifetime dollar limits."

The study says that insurance regulations and fundamental changes in the way mental health services are delivered have altered the environment in which mental health coverage is bought and sold.

It finds, for instance, that health plans that administer their own mental health services and others that carve it out offer comparable benefits.

"We found relatively little difference in the benefit design features of people with carve-out versus integrated mental health coverage," the authors report.

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