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Behavioral health care benefit premiums were slashed 670 percent more than general health care benefit premiums during the past 10 years, according to a new study by the Hay Group, an actuarial and benefits consulting firm in Washington, D.C.
The value of general behavioral health care benefits has declined 7 percent (from $2,326.86 per covered individual in 1988 to $2,155.60 in 1997), and the value of behavioral health care benefits has declined 54 percent (from $154.08 in 1988 to $69.61 in 1997).
The Hay Group study, "Health Care Plan Design and Cost Trends: 1988 through 1997," is the first to compare the status of behavioral and general health care in terms of benefits value across a period of years.
The study was commissioned by the National Association of Psychiatric Health Systems (NAPHS), which represents the nation's behavioral health care provider organizations; the National Alliance on Mental Illness (NAMI); and the Association of Behavioral Group Practices (ABGP). The NAPHS Education and Research Foundation funded the study.
"The revolution that has swept health care over the past 10 years has had a particularly strong negative impact on behavioral health," said William D. Zieverink, M.C., president of NAPHS and a psychiatrist with Behavioral Health Strategies in Portland, Ore. It is important to control health care costs, he said, but "the trend of slashing behavioral health dollars appears to be continuing unabated. Even when recognizing the need to cut costs and eliminate waste from the system, behavioral health benefits have been disproportionately cut compared to general health care benefits."
"The erosion of behavioral health dollars is simply discrimination in another-very dangerous-form," added Laurie Flynn, NAMI executive director. "This type of discrimination means that resources desperately needed by those with serious brain disorders are being eliminated."
One aspect of the decrease in behavioral health money is that the number of plans with annual visit limits for outpatient behavioral health care has nearly doubled. In 1997, 48 percent of plans imposed annual visit limits for outpatient behavioral health care compared with just 26 percent in 1988, according to the Hay Group report. By 1997, the most prevalent limit was 20 outpatient visits. In contrast, 46 percent of the plans that imposed a visit limit in 1988 allowed a maximum of 50 visits. Today, only 17 percent allow 50 visits.
"This report suggests once again that individuals with serious mental illnesses and their families who most need access to effective treatments are benefiting the least," said Flynn.
Results of the Hay study indicate a need to consider seriously the implications of severe loss of funding and loss of access on the lives of real people, said Leonard Goldstein, M.D., president of the Association of Behavioral Group Practices. Such losses contribute to turnover and absenteeism at work and sometimes high hospitalization costs.
"We all want to control costs," he said, "but how far is too far? This study should encourage all employers and payers to take a second look at their benefit design for behavioral health to be certain that it can deliver what they expect it to."
NAPHS, ABGP, and NAMI have created an action plan for the Hay study that involves distributing it to employers and sharing information with health care leaders, policymakers, and other associations that can in turn distribute it in their local areas. They will provide copies of the report to all Fortune 500 companies, along with a checklist of questions to help employers reevaluate their own behavioral health benefit plans to make certain they are receiving the access, quality, and cost-effective services they expect. In addition, NAPHS and ABGP have begun an effort to standardize data collection and reporting for all levels of care within behavioral health care systems.
The Hay Benefits Report collects yearly data on the typical design of health care benefits provided by medium and large employers in the United States. Data from these reports were extracted and used for this study. The benefits for each year were coded into Hay's Mental Health Benefit Value Comparison (MHBVC) model. MHBVC was developed by the Hay Group for the National Institute of Mental Health to provide estimates of the costs of mental health parity.
"The prevalence of mental and addictive disorders is high," said Goldstein. "The impact of these disorders, when left untreated, is very high-both in economic and human terms. Behavioral health issues need to be on the radar screen of every employer in the nation."
The report is available by accessing the Web site