Growth in Spending on and Use of Services for Mental and Substance Use Disorders After the Great Recession among Individuals with Private Insurance
OBJECTIVE:
Recessions
are associated with increased prevalence of mental and substance use disorders,
but their effect on use of behavioral health services is less clear. This study
examined changes in spending per enrollee for behavioral health services
compared with general medical services among individuals with private insurance
following the Great Recession that began in 2007.
METHODS:
The
National Survey on Drug Use and Health was used to examine the prevalence of
behavioral health conditions among persons with private insurance from 2004 to
2013. Truven Health MarketScan Commercial Claims and Encounters data
(2004-2012) were used to calculate use of and spending on treatment of
behavioral and general medical conditions before and after the recession among
individuals with employer-sponsored private health insurance.
RESULTS:
There was
a statistically significant increase in serious psychological distress and
episodes of major depression between 2007 and 2010. Between 2004-2009 and
2009-2012, the growth in average annual spending per individual slowed for
general medical care (from 6.6% to 3.7%) but accelerated for behavioral health
care (from 4.8% to 6.6%). From 2009 to 2012, the percentage of individuals
receiving inpatient treatment, outpatient treatment, and prescription drugs for
behavioral conditions increased, whereas use of these services for general
medical care decreased or remained flat. Out-of-pocket costs increased more
slowly for behavioral conditions than for other medical conditions.
CONCLUSIONS:
The
recession was associated with increased need for and use of behavioral health
services among individuals with private insurance. The Mental Health Parity and
Addiction Equity Act may have also played a role in facilitating increasing use
of behavioral health services after 2008.
1Dr. Mark and Ms. Levit are with the Center for
Behavioral Health Services Research, Truven Health Analytics (http://truvenhealth.com/), Washington, D.C.
(e-mail: tami.mark@truvenhealth.com ). Dr. Hodgkin is with the Heller School
for Social Policy and Management and Dr. Thomas is with the Schneider Institute
for Health Policy, Brandeis University, Waltham, Massachusetts.
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