Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management]
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J Policy Anal Manage · Jan 2008
Mental health and substance abuse insurance parity for federal employees: how did health plans respond?
A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable illnesses, such as mental illness. Since the inception of employer-based health insurance, coverage for mental health services has been offered on a more limited basis than coverage for general medical services. While mental health advocates view insurance limits as evidence of discrimination, adverse selection and moral hazard can also explain these differences in coverage. ⋯ In this study, we examine how health plans responded to the parity directive. Results show that in comparison with a set of unaffected health plans, federal employee plans were significantly more likely to augment managed care through contracts with managed behavioral health "carve-out" firms after parity. This finding helps to explain the absence of an effect of the FEHB Program directive on total spending, and is relevant to the policy debate in Congress over federal parity.
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Policymakers are increasingly concerned that a relatively new class of anti-depressant drugs, selective serotonin re-uptake inhibitors (SSRI), may increase the risk of suicide for at least some patients, particularly children. Prior randomized trials are not informative on this question because of small sample sizes and other limitations. Using variation across countries over time in SSRI sales and suicide, we find that an increase of one pill per capita (a 13 percent increase over 1999 levels) is associated with a 2.5 percent reduction in suicide rates, a relationship that is more pronounced for adults than for children. Our findings suggest that expanding access to SSRIs for adults may be a cost-effective way to save lives, although policymakers are right to remain cautious about pediatric use of SSRIs.
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In the wake of significant budget shortfalls, 37 states and the District of Columbia have recently increased cigarette excise taxes to boost revenues. This study examines the impact of increasing the price of cigarettes, which will occur as a consequence of cigarette excise tax increases, and implementing restrictions on smoking in private worksites, restaurants, government worksites, healthcare facilities, and other public places on young adult smoking progression. ⋯ The estimates clearly indicate that increasing the price of cigarettes would substantially decrease the number of young adults who progress into higher intensities of smoking. In addition, private worksite restrictions and restrictions on smoking in other public places are found to decrease moderate smoking uptake among young adults.