Mental Health Parity Law May Not Mean Greater Access to Care

HealthLeaders Media Staff, April 21, 2009

Even with the passage last year of national mental health parity legislation, large gaps in access to mental healthcare services appear likely to remain—unless these issues are addressed in upcoming healthcare reform efforts, according to a new study.

In particular, the new parity law likely will have no major effect on severe access problems to mental health services for the uninsured, as well as problems related to the shortage of mental healthcare providers in some areas, says Peter Cunningham, PhD, a senior fellow at the Center for Studying Health System Change in Washington, who conducted the study. The study appears as a Web exclusive this month in the journal Health Affairs.

About two thirds of primary care physicians reported in 2004 05 that they could not get outpatient mental health services for patients, which is more than twice the rate reported for three other common referrals: other specialists (33.8%), imaging services (29.8%), and nonemergency hospital admissions (15.8%). This data was obtained through a survey that tracks the experiences of primary care physicians in 60 communities across the country.

While the survey data preceded passage of the Wellstone Domenici Mental Health Parity and Addiction Equity Act of 2008—which mandated mental health parity in private insurance benefits—the study found that some states' mental health parity laws only had a small effect on decreasing mental health access disparities.

"I don't think we'll see a big difference after parity is fully implemented," Cunningham said in an interview. "I think the question is if there is meaningful health reform this year. And, assuming health reform will include mental health care . . . then I think that's when you would expect to see a much bigger impact."

"What the parity legislation did is address the discrepancy in coverage of mental health services from physical health services—but that only applies to private insurance policies that provide any mental health coverage," he said. "It doesn't require health plans to provide mental health services. If they do, then it has to be comparable to the benefits for physical health problems."

The study also found that communities with high numbers of underinsured and uninsured people tended to have only small percentages of their insured populations enrolled in health maintenance organizations. Enrollment in HMOs might otherwise offset some of the coverage and provider shortage problems through better coordination and integration of care and lower cost sharing, Cunningham noted.

Provider availability was another issue. For example, pediatricians were more likely than other primary care physicians to report problems getting mental health services for their patients because of health plan barriers and shortages of mental health providers—and not because of lack of or inadequate coverage.

The lack of access to specialty mental health providers in turn is likely a contributing factor to the rising rates of mental health problems being treated in the general medical sector, the study noted. Also, problems with mental health care access are especially severe for the low income uninsured—even for many Medicaid enrollees—as public mental health services are cut back in many areas.

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