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Health cost cuts don’t sway seniors

BROWN (US) — Deep cuts in co-pays for outpatient mental health care aren’t enough to motivate senior citizens to get the care they need.

Parity legislation passed in 2008 and 2010, ended an insurance industry practice of charging higher co-pays for mental health care than for other care, but while the laws save seniors money, new research finds co-pays are not the main barrier to care.

“Less than half of people with a mental health condition actually seek mental health services,” says Amal Trivedi, professor of community health at Brown University.

“The hope was that insurance parity and reducing co-pays would increase the number of people who would do so. We found that’s unlikely to be the case. At least for this population in managed care plans, rather large increases or decreases in co-pays have no effect on the likelihood of receiving any outpatient mental health care.”

The study is published online in the journal Medical Care.

Trivedi and graduate student Chima Ndumele combed through 252 Medicare plans with outpatient mental health services. They found 14 that raised co-pay rates by more than 25 percent in the last year of a three-year period, and that could be compared to plans that were similar except that they held co-pay rates constant.

They also found three plans that lowered rates by more than 25 percent in a third year that could also be compared to comparable control plans that did not change their co-pay.

Among enrollees in the 14 plans that raised rates, an average of 2.2 percent used mental health services both before and after the increase. In the case of the plans that lowered rates, participation in mental health care held steady at 1.2 percent of enrollees, despite the discount.

In both cases, the plans that did not change co-pays averaged a 0.1-percent drop in mental health service use. In short, mental health service use essentially remained unchanged no matter what happened to the co-pay.

The non-effect held true for almost every demographic breakdown of the enrollees, except that black seniors seemed to be motivated by reduced co-pays, increasing their participation in mental health care by almost a whole percentage point.

At least a partial explanation for the tiny effect of co-pay changes is that other common insurance company policies may have a stronger effect on limiting use of mental health services for most seniors, Trivedi says.

Those policies include requiring prior authorization of care from primary care doctors and the insurer, and restricted networks of doctors approved to provide mental health care.

“The people who actually receive mental health services have already overcome these additional barriers to use of services,” he says. “If the plan had prior authorization or restricted network, it meant enough for them to go past those barriers. Putting in another co-pay increase didn’t dissuade them from receiving services.”

Similarly, these policies are probably more of a barrier to seniors starting care than the level of the co-pay.

“Enacting parity is just one step in creating an environment in which individuals in need of mental health services will seek care,” adds Ndumele. “Our study indicates that we must identify other steps beyond insurance parity to promote the appropriate use of mental health services among the elderly.”

The study was funded by the National Institutes of Health through a grant from the Minority Opportunities for Research (MORE) Division of the National Institute of General Medical Sciences.

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