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Articles   |    
Impact of Comprehensive Insurance Parity on Follow-Up Care After Psychiatric Inpatient Treatment in Oregon
Neal T. Wallace, Ph.D.; K. John McConnell, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200465
View Author and Article Information

Dr. Wallace is affiliated with the Mark O. Hatfield School of Government, Portland State University, P.O. Box 751, Portland, OR 97207 (e-mail: nwallace@pdx.edu). Dr. McConnell is with the Center for Health Systems Effectiveness and the Department of Emergency Medicine, Oregon Health and Science University, Portland.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study assessed the impact of Oregon’s 2007 parity law, which required behavioral health insurance parity, on rates of follow-up care provided within 30 days of psychiatric inpatient care.

Methods  Data sources were claims (2005–2008) for 737 individuals with inpatient stays for a mental disorder who were continuously enrolled in insurance plans affected by the parity law (intervention group) or in commercial, self-insured plans that were not affected by the law (control group). A difference-in-difference analysis was used to compare rates of follow-up care before and after the parity law between discharges of individuals in the intervention group and the control group and between discharges of individuals in the intervention group who had or had not met preparity quantitative coverage limits during a coverage year. Estimates of the marginal effects of the parity law were adjusted for gender, discharge diagnosis, relationship to policy holder, and calendar quarter of discharge.

Results  The study included 353 discharges in the intervention group and 535 discharges in the control group. After the parity law, follow-up rates increased by 11% (p=.042) overall and by 20% for discharges of individuals who had met coverage limits (p=.028).

Conclusions  The Oregon parity law was associated with a large increase in the rate of follow-up care, predominantly for discharges of individuals who had met preparity quantitative coverage limits. Given similarities between the law and the 2008 Mental Health Parity and Addiction Equity Act, the results may portend a national effect of more comprehensive parity laws.

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Table 1Characteristics of discharges among the intervention and control groups, 2005–2008a
Table Footer Note

a The intervention group consisted of individuals enrolled in insurance plans affected by the parity law, and the control group consisted of individuals enrolled in commercial, self-insured plans that were not affected by the parity law.

Table Footer Note

b Includes only discharges from before January 1, 2007, when the parity law took effect. Discharges of individuals in the intervention group also include discharges that occurred in 2007 up until the first date of renewal of the insurance plan.

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Table 2Estimated average marginal effects of study variables on rates of follow-up care after the parity law
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Table 3Characteristics of discharges of individuals in the intervention group who had or had not met preparity quantitative coverage limitsa
Table Footer Note

a The intervention group consisted of individuals enrolled in insurance plans affected by the parity law.

Table Footer Note

b Includes only discharges that occurred before January 1, 2007, or in 2007 up until the first date of renewal of the insurance plan

Table Footer Note

c Proportions were compared by chi square tests.

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Table 4Estimated average marginal effects of study variables on rates of follow-up care for discharges of individuals who had met preparity quantitative coverage limitsa
Table Footer Note

a Includes only individuals who were enrolled in insurance plans affected by the parity law

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