Are state mental health insurance mandates effective?

摘要

From 1997 to 2001, several state legislatures passed laws mandating that employers must offer mental health insurance coverage if they provide general medical health benefits. Previous research has failed to determine whether these mandates have had a causal effect on access to mental healthcare and mental health outcomes. This dissertation employs a difference-in-differences estimation strategy to evaluate the effect of three types of mental health mandates (full parity, minimum mandated benefits, and mandated offering) on the rate of mental health insurance coverage, the utilization of mental healthcare services, and four measures of mental health outcomes using two waves of data from the National Survey of Alcohol, Drug and Mental Health Problems. The results suggest that full parity mental health mandates broadly increase the likelihood of mental health insurance coverage among individuals with employer-sponsored health insurance, but decrease the probability of mental health insurance coverage among individuals with employer-sponsored health insurance who are in poor mental health status. Additionally, mental health mandates broadly cause an increase in utilization of mental healthcare services with the effect increasing with the strength of the mandate. Finally, mental health mandates do not appear to have a significant effect on the probability of having major depression disorder, worker unemployment and worker absenteeism. However, they do significantly and negatively affect a measure of an individual's mental health status, the social functioning score. Therefore, mandates improved mental health insurance coverage for the marginal patient, but worsened coverage for individuals with poor mental health status, thus resulting in a decline in mental health status outcomes across the whole sample. Overall, this dissertation finds evidence suggesting that state mandates for mental health are not an effective means for improving mental health outcomes and for those in poor mental health, they actually have the adverse effect of worsening coverage as well as mental health status.