MENTAL HEALTH COVERAGE: Big Drop In Benefits Found
Behavioral health care benefit costs have been "slashed" 670% more than general health care benefit costs over the last 10 years, according to a new study jointly funded by the National Alliance for the Mentally Ill, the National Association of Psychiatric Health Systems and the Association of Behavioral Group Practices. The report, prepared by the Washington, DC-based consulting firm the Hay Group, found that general health care benefits have declined only 7%, from $2,326.86 per covered individual in 1988 to $2,155.60 in 1997. That decline compares to a 54% drop in the value of behavioral health care benefits, from $154.08 per covered individual in 1988 to $69.61 in 1997. In addition, the study found that as a percent of the total health care benefits, behavioral health benefits have "plummeted" 50%, dropping from 6.2% in 1988 to 3.1% in 1997. "The revolution that has swept health care over the past ten years has had a particularly strong negative impact on behavioral health ... however, the trend of slashing behavioral health dollars appears to be continuing unabated. Even when recognizing the need to cut costs and eliminate waste from the system, behavioral health benefits have been disproportionately cut compared to general health care benefits," said Dr. William Zieverink, president of NAPHS. "The erosion of behavioral health dollars is simply discrimination in another -- very dangerous -- form," said Laurie Flynn, NAMI executive director.
The study, entitled "Health Care Plan Design and Cost Trends: 1988 through 1997," looked at plan benefit design compiled in the annual Hay Benefits Report, which collects data from 1,043 U.S. employers representing "a broad industry and geographic mix." The data were coded into Hay's Mental Health Benefit Value Comparison model to estimate the costs of mental health parity. The study found that behavioral health care has been increasingly subjected to different limits, caps and deductibles. And unlike the general health care sector where there has been a shift to greater outpatient care, behavioral health services are being "squeezed" on both the inpatient and outpatient sides. The number of plans with limits on outpatient behavioral health visits increased to 48% in 1997, up from 26% in 1988. The number of plans imposing a limit on inpatient psychiatric care increased from 63% in 1990 to 86% in 1997.
The Mutual of Omaha Report
The Hay study also cited an annual Mutual of Omaha report, which found office psychiatric encounters among its policyholders dropped 8.9% between 1991 and 1996 and dropped 28.3% as a proportion of all outpatient office visits during the same period. In addition, the Mutual of Omaha report found that the average charge per outpatient visit declined 7% in 1997 dollars, compared to a 5.9% increase for general office visits for all diagnoses. And Mutual of Omaha reported a 50% drop in the average length of hospital stays for behavioral health disorders between 1991 and 1996, in contrast to an 18.3% drop for average length of stays for all diagnoses. The report also found that inpatient behavioral health days per 1,000 people dropped 68.8%, from 93 days per 1,000 people in 1991 to 29 days per 1,000 in 1996. The Hay Group suggests that the Mutual of Omaha findings "reflect national trends."
Cause For Concern
According to Dr. Leonard Goldstein, ABGP president, "It is time to seriously consider the implications of severe loss of funding and loss of access on the lives of real people." He added, "The prevalence of mental and addictive disorders is high. The impact of these disorders when left untreated is very high -- both in economic and human terms. Behavioral health issues need to be on the radar screen of every employer in the nation." The three groups sponsoring the Hay Group study have joined together to develop an Employer's Checklist designed to help purchasers of behavioral health benefits evaluate their own benefits plans. The checklist is available online at http://www.naphs.org (joint release, 5/7).