Association for Public Policy Analysis & Management

Commercial insurance for the treatment of eating disorders has historically been even more limited than for conditions such as depression and schizophrenia. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 was intended to address benefit limits for services including eating disorders, including higher copayments and special annual limits on the number of inpatient days and outpatient visits covered. MHPAEA could expand access to such services and improve financial protection for individuals with eating disorders and their families. However, in a national survey of commercial plans, Horgan et al. found that 22.4% of health plans did not cover eating disorder services in 2010, the first year after implementation. In addition, multiple lawsuits brought by parties alleging violations of MHPAEA have involved the treatment of eating disorders. Little is known about the impact of federal parity on the quantity of eating disorder services used or spending for these services.

To examine this research question, we used the Truven Health MarketScan data (2007 to 2012) included health insurance claims and enrollment information for employees and their dependents. The study population included adolescents and adults ages 13-64 with an inpatient or outpatient claim with a primary eating disorder diagnosis during the six-year study period from 2007 through 2012 (N=34,229). Among individuals diagnosed with an eating disorder, we examined whether federal parity was associated with changes in the number of outpatient mental health services, medication management visits, and psychotherapy visits, as well as total spending and out-of-pocket (OOP) spending on mental health services. We used an interrupted time series model to compare trends observed in the post-parity period with what would have been expected given trends observed in the pre-parity period. Autocorrelation of measures across time was accounted for using Yule-Walker regression models.

We found significant increases in trends in the number of outpatient mental health services and psychotherapy services among those using those specific types of services. These changes were small in magnitude. For example, they translated into an additional 2 outpatient mental health visits and nearly 1 and a half additional psychotherapy visits, on average, among individuals using those services in 2010, the first year in which the federal parity law was implemented. We detected small but statistically significant increases in trends post-implementation in both total mental health spending (p<0.0001) and OOP mental health spending (p=0.049) among mental health service users. In the first year post implementation, for example, the average increase in total mental health spending amounted to $388.85 per service user and the average increase in OOP mental health spending amounted to $51.26 per user.

In conclusion, we found modest increases in the number of outpatient services paid for by private insurance, and increases in total spending and OOP spending on mental health services for the treatment of eating disorders. Individuals with eating disorders use more services following implementation of federal parity but, contrary to expectations, the law did not appear to lower the financial burden associated with treating these conditions.