Table 2.
Out-of-Pocket Spending on Outpatient Mental Health Visits among Self-Insured Enrollees (Exposure Group) and Small Employer Enrollees (Comparison Group) in the Propensity Matched Cohorta
| Mean Spending ($) | Mean Change From Baseline to Follow-Up, Exposure Group vs Comparison Group | |||||||
|---|---|---|---|---|---|---|---|---|
| Exposure Group (n=11,226) | Comparison Group (n=11,226) | Absolute Spending ($) | Relative, % | |||||
| Pre (95%CI) | Post (95%CI) | Pre (95% CI) | Post (95% CI) | Est. (95% CI) | p-value | Est. (95% CI) | p-value | |
| OVERALL COHORT | ||||||||
| MHPAEA, Year 1 | ||||||||
| OOP Spending per Visit | 30.98 (30.57,31.39) | 33.67 (33.21,34.13) | 37.10 (36.65,37.54) | 40.52 (40.05,40.99) | −0.74 (−1.40,−0.07) | 0.03* | −0.51 (−2.39,1.36) | 0.59 |
| Total OOP Spending per Enrollee | 214.02 (208.73,219.30) | 232.99 (227.08,238.89) | 246.99 (240.45,253.54) | 265.52 (258.20,272.85) | 0.44 (−8.11,8.99) | 0.92 | 1.27 (−2.30,4.84) | 0.49 |
| MHPAEA, Year 2 | ||||||||
| OOP Spending per Visit | 30.98 (30.57,31.39) | 34.73 (34.25,35.22) | 37.10 (36.65,37.54) | 42.88 (41.90,43.85) | −2.03 (−3.17,−0.89) | <0.001* | −3.01 (−5.80,−0.22) | 0.04* |
| Total OOP Spending per Enrollee | 214.02 (208.73,219.30) | 238.39 (232.47,244.32) | 246.99 (240.45,253.54) | 264.52 (257.70,271.34) | 6.85 (−2.28,15.98) | 0.14 | 4.01 (0.01,7.92) | 0.05 |
| SPENDING QUARTILE 1: LOWEST BASELINE SPENDERS ON MENTAL HEALTH OUTPATIENT VISITS | ||||||||
| MHPAEA, Year 1 | ||||||||
| OOP Spending per Visit | 18.69 (18.13,19.24) | 30.82 (29.70,31.93) | 23.38 (22.72,24.03) | 36.09 (35.08,37.09) | −0.58 (−2.15,0.99) | 0.47 | 6.82 (0.97,12.67) | 0.02* |
| Total OOP Spending per Enrollee | 25.07 (22.92,27.22) | 111.12 (102.88,119.37) | 30.31 (28.17,32.46) | 118.56 (110.11,127.02) | −2.20 (−12.14,7.75) | 0.67 | 13.32 (0.00,26.53) | 0.05 |
| MHPAEA, Year 2 | ||||||||
| OOP Spending per Visit | 18.69 (18.13,19.24) | 32.45 (31.28,33.62) | 23.38 (22.72,24.03) | 40.47 (36.18,44.76) | −3.33 (−7.94,1.27) | 0.16 | 0.29 (−12.03,12.61) | 0.96 |
| Total OOP Spending per Enrollee | 25.07 (22.92,27.22) | 121.67 (112.91,130.43) | 30.31 (28.17,32.46) | 132.85 (123.59,142.11) | −5.94 (−17.19,5.32) | 0.30 | 10.73 (−2.57,24.04) | 0.11 |
| SPENDING QUARTILE 2: LOW-MEDIUM BASELINE SPENDERS ON MENTAL HEALTH OUTPATIENT VISITS | ||||||||
| MHPAEA, Year 1 | ||||||||
| OOP Spending per Visit | 26.35 (25.79,26.90) | 31.41 (30.58,32.24) | 30.96 (30.36,31.57) | 36.26 (35.40,37.11) | −0.23 (−1.37,0.91) | 0.69 | 1.81 (−1.80,5.42) | 0.33 |
| Total OOP Spending per Enrollee | 85.45 (83.98,86.91) | 140.16 (134.29,146.03) | 95.42 (93.91,96.92) | 162.53 (155.21,169.85) | −12.40 (−21.80,−3.09) | 0.009* | −3.70 (−9.73,2.33) | 0.23 |
| MHPAEA, Year 2 | ||||||||
| OOP Spending per Visit | 26.35 (25.79,26.90) | 33.29 (32.39,34.18) | 30.96 (30.36,31.57) | 39.18 (38.20,40.16) | −1.27 (−2.60,−0.05) | 0.06 | −0.14 (−4.01,3.72) | 0.94 |
| Total OOP Spending per Enrollee | 85.45 (83.98,86.91) | 159.11 (152.04,166.18) | 95.42 (93.91,96.92) | 174.90 (167.07,182.73) | −5.82 (−16.31,4.68) | 0.28 | 1.59 (−4.96,8.13) | 0.63 |
| SPENDING QUARTILE 3: MEDIUM-HIGH BASELINE SPENDERS ON MENTAL HEALTH OUTPATIENT VISITS | ||||||||
| MHPAEA, Year 1 | ||||||||
| OOP Spending per Visit | 32.25 (31.55,32.95) | 34.02 (33.20,34.83) | 38.54 (37.75,39.34) | 40.91 (40.05,41.76) | −0.60 (−1.78,0.59) | 0.33 | −0.61 (−3.87,2.64) | 0.71 |
| Total OOP Spending per Enrollee | 186.81 (184.26,189.37) | 212.33 (204.95,219.72) | 200.77 (198.15,203.39) | 233.01 (223.62,242.40) | −6.72 (−18.70,5.26) | 0.27 | −2.07 (−7.35,3.22) | 0.44 |
| MHPAEA, Year 2 | ||||||||
| OOP Spending per Visit | 32.25 (31.55,32.95) | 34.86 (33.98,35.73) | 38.54 (37.75,39.34) | 42.53 (41.60,43.47) | −1.38 (−2.68,−0.09) | 0.04* | −2.06 (−5.49,1.38) | 0.24 |
| Total OOP Spending per Enrollee | 186.81 (184.26,189.37) | 224.02 (215.83,232.22) | 200.77 (198.15,203.39) | 239.80 (230.25,249.34) | −1.82 (−14.42,10.79) | 0.78 | −0.40 (−5.10,5.90) | 0.89 |
| SPENDING QUARTILE 4: HIGHEST BASELINE SPENDERS ON MENTAL HEALTH OUTPATIENT VISITS | ||||||||
| MHPAEA, Year 1 | ||||||||
| OOP Spending per Visit | 42.15 (41.20,43.09) | 38.73 (37.80,39.67) | 50.01 (49.11,50.92) | 47.72 (46.75,48.69) | −1.12 (−2.49,0.25) | 0.11 | −3.67 (−6.68,−0.67) | 0.02* |
| Total OOP Spending per Enrollee | 558.96 (545.24,572.68) | 434.38 (418.04,450.72) | 642.52 (624.12,660.91) | 489.42 (468.89,509.94) | 28.52 (3.90,53.14) | 0.02* | 2.02 (−3.04,7.08) | 0.43 |
| MHPAEA, Year 2 | ||||||||
| OOP Spending per Visit | 42.15 (41.20,43.09) | 38.82 (37.83,39.81) | 50.01 (49.11,50.92) | 48.96 (47.89,50.02) | −2.28 (−3.76,−0.79) | 0.003* | −5.91 (−9.07,−2.75) | <0.001* |
| Total OOP Spending per Enrollee | 558.96 (545.24,572.68) | 401.69 (386.28,417.10) | 642.52 (624.12,660.91) | 446.45 (428.31,464.59) | 34.80 (13.35,64.24) | 0.003* | 3.42 (−2.09,8.94) | 0.22 |
Abbreviations: MHPAEA, Mental Health Parity and Addiction Equity Act; OOP, out-of-pocket.
*
p<0.05
a
All rates and changes estimated using the Stata margins and/or nlcom commands and adjusted for age, gender, race/ethnicity, education level, poverty level, ACG score, state of residence, and plan renewal month.