The final rules are out and it seems that the quest for mental health parity has been wholly successful. I’m convinced that almost no one understands what it means (see our previous post). Nonetheless, everyone is cheering.
Everyone that is, except for a few of us here at the NCPA. This is from a Health Alert I wrote six years ago:
Here’s the question: Would you want an insurance plan that had the same deductible and co-payment for every procedure? Need time to think about that? Then try this: Does it make sense to have the same deductibles and co-payments for chiropractic therapy as for setting a broken leg? Or from the mental health field, should the payment terms that cover bipolar disorder be the same as those that apply to marriage counseling (required coverage in some states)? Should pastoral counseling (also required in some places) be reimbursed the same way as coverage for schizophrenia? If you have any sense, the answers are: No, No, No and No.
One way to keep insurance costs down is through incentives. Patients should pay more of their bill when they exercise discretion and especially where patient discretion is appropriate. In mental health, this principle applies in spades because:
- the illness is often experienced subjectively,
- there are often no objective standards for diagnosis or treatment,
- doctors often exercise enormous discretion,
- patients also exercise a lot of discretion and
- patient cooperation is often crucial to any cure.
Unlike fixing a broken leg, these are precisely the conditions that make patient cost sharing highly desirable.
If I haven’t convinced you so far, consider this National Bureau of Economic Research study finding: 38 percent of all mental health patients ― representing 28 percent of all treatment visits ― are people who do not have any mental health disorder.