Abstract:

A fundamental concern with competitive health insurance markets is that, if left unregulated, they will not supply efficient levels of coverage for the treatment of mental illness. Parity regulations aim to eliminate differences in insurance for these conditions compared with other medical services. The emergence of managed care over the last decade has created supply-side rationing mechanisms that may weaken the ability of parity policies to curb responses to selection incentives. This thesis studies behavioral responses to parity regulation from the perspectives of the health plan, the consumer, and politicians and interest groups.

Paper 1 examines health plan response to a comprehensive mental health parity directive for federal employees. Results show that plans complied with the policy and did not exit the federal employee program due to parity as had been feared by some policymakers. However, in comparison with unaffected health plans, federal employee plans were significantly more likely to contract with managed behavioral health carve-out firms after parity.

Paper 2 studies the effect of state parity laws on consumer utilization of outpatient mental health services and out-of-pocket price. Structural shift estimates calculated from a three equation demand model predict a 30 percent increase in expected visits due to parity. However, using data from a subsequent time period, these differences are no longer detected even when the most comprehensive laws are compared to non-parity states. Parity laws do not appear to affect the price paid by consumers for outpatient specialty mental health services.

Paper 3 studies how strategic political actors have used data, symbolic devices, and narrative-based emotional appeals to frame the terms of the debate over mental health parity in the U.S. Congress and state legislatures. Both supporters and opponents of parity have attempted to influence perceptions about the effectiveness and cost of treating mental disorders, and the mental health community has also used personal narrative to overcome their disadvantage in more traditional advocacy resources. Salient policy images have been particularly influential given low public attention and the limited role of partisan affiliation and political ideology in the parity debate.