Table 3.
Cost Impact of MH/SA Benefit Expansion by Individual Employers
| Author, Year |
Study Design |
Data source/ Measurement Carveout? |
Benefits Expansion | Change in Plan Cost PPPY | Premium for Corresponding year |
Change in Plan Cost PPPY as Percentage of Insurance Premiums PPPY |
|---|---|---|---|---|---|---|
| Sturm 199830 | Pre-Post | Claims for MH/SA for plan-holders and dependents from 1995–1997 to estimated costs from management reports for prior years. Plans were carved-out. |
The State of Ohio employee’s health benefits plan | For indemnity plans, the study estimated that cost per covered person covered decreased $15.20 from 1992–1993 to 1996–1997. For HMOs, which started from limited MH/SA benefits, increased from $43.92 in 1993 to $55.92 in the post 1995–1996 year and then declined to $43.68 in 1996–1997, an overall increase of $5.88 per covered person from 1993–1994 to 1996–1997 |
$2,011 in year 1996a | Indemnity plans: −0.76% HMO: 0.29% |
| Sasso 200629 | Pre-Post with Comparison | Claims for MH/SA from plan-holders only. Presence of carve-out not clear |
Voluntary expansion of MH/SA benefits in 1996 by a large Midwestern manufacturing company | The difference in difference change in cost per person from 1995 to 1998 was an increase of $21.84 | $2,034 in 1997b | 1.07% |
| Grazier 200024 | Pre-Post | Claims for MH/SA from plan-holders only from 1990 through 1993 for large corporation’s California-based employees MH/SA was carved out |
Large employer that voluntary expanded MH/SA benefits in 1991 | MH/SA cost per person decreased by $6.27 from 1990 to 1991–1993. | $2,241 in year 1996c | −0.28% |
| Cuffell 199922 | Pre-Post | MH/SA claims from 1991 through 1995 for plan-holders and dependents in PPO. MH/SA carved out |
Effect on plan cost for a large employer that expanded MH/SA benefits in 1993 | Cost per covered life per year decreased by $134.25 from 1991 to 1992–1995. (Net payment assumed to exclude OOP Cost) |
$1,993 in year 1996d | −6.74% |
| Zuvekas 2002, 200531–33 | Pre-Post with Comparison | MH/SA claims for plan-holders and dependents from 1 year pre and 3 years post expansion. MH/SA carved out. |
Large employer that had voluntarily expanded MH/SA benefits | The first two papers31,33 found a large reduction in MH/SA medical cost per person, substantially due to reduced in-patient visits and stays and the later third paper32 found that the pharmacy cost per person increased with substantially more prescriptions for psychotropics. Overall, the study found that the net effect was to leave cost per person unchanged. | $1,993 in year 1996d | 0% |
Weighted total single (=$2,306) and family (=$5,579) premium per plan-holder through state government jobs: East-North-Central Region, MEPS-IC data. Assumed 50% opted for single coverage. Ratio of covered persons to plan-holders determined from US Census-CPS data for 2002 (=1.96). $2,011 = (2306*0.5+5579*0.5)/1.96
Average total single coverage premiums (=$2,034) for mixed-provider plans per plan-holder at private sector firms with =>1K employees in 1997, MEPS-IC data.
Average total single premium (=$2,241) for mixed provider plans per plan-holder in private-sector establishments with =>1K employees that offer health insurance: State of California, MEPS-IC data.
Average total single (=$2,028) and family (=$5,059) premium for mixed-provider plans per plan-holder in firms with =>1K employees and percentage opting for single coverage (=38%), MEPS-IC data. Ratio of covered persons to plan-holders determined from US Census-CPS data for 2002 (=1.96). $1993 = (2028*38/100+5059*(100−38)/100)/1.96
Note: Abbreviations: MH/SA, mental health/substance abuse; PPPY, per person per year; SA, substance abuse; MEPS-IC, Medical Expenditure Panel Survey-Insurance Component; CPS, Current Population Survey.