Table 1.

Levels of Spending and Percent of Spending Out-of-Network

	2008–2010 (N = 14,489,925)		2011–2013 (N = 15,672,236)		2014–2016 (N = 16,951,922)		Average annual change in percent out-of-network (95% CI)‡	P value
	Average annual spending ($)*	Percent out-of-network (%)†	Average annual spending ($)*	Percent out-of-network (%)†	Average annual spending ($)*	Percent out-of-network (%)†
All mental and behavioral health services	40,162	29.2	53,683	30.2	68,606	29.7	− 0.18 (− 0.67, 0.32)	0.49
All services provided by psychiatrists	12,416	25.8	16,084	26.8	18,959	25.5	− 0.17 (− 0.55, 0.22)	0.39
Places of service for mental and behavioral health§	2801	12.6	3973	21.6	4850	34.4	2.07 (1.05, 3.08)	< 0.001
Place of service
Community mental health center	271	51.5	314	34.3	387	17.9	0.58 (− 0.65, 1.81)	0.36
Inpatient psychiatric facility	375	10.2	147	15.2	130	16.8	1.23 (0.63, 1.83)	< 0.001
Non-residential substance abuse facility	50	5.3	97	28.6	173	42.8	2.23 (− 0.03, 4.49)	0.05
Partial hospital psychiatric facility	1056	11.5	1555	24.2	2258	41.5	5.41 (3.66, 7.15)	< 0.001
Residential substance abuse facility	841	11.6	1560	24.4	1708	44.3	2.75 (1.41, 4.10)	< 0.001
Psychiatric residential treatment center	208	25.0	299	11.2	196	11.5	− 3.21 (− 8.09, 1.68)	0.20

*Average annual spending is expressed as dollars per 1000 individuals, inflation-adjusted to 2016 US dollars

^†Percent of spending out-of-network was calculated by dividing out-of-network spending by the sum of out-of-network and in-network spending

^‡Average annual changes in the share of spending out-of-network were estimated using an enrollee-level ordinary least squares model adjusted for age, sex, health risk, insurance plan, and region

^§Places of service for mental and behavioral health were separately analyzed