Some of the savings from insurance companies spending less on mental-health care over the past decade should help lift restrictions on access to care, advocates say.
As inflation-adjusted spending has been cut in half, health plans have increasingly imposed restrictions. A typical health plan might pay for just 20 visits to a psychiatrist, while a diabetic could see a doctor as many times as the doctor felt was necessary."It's discrimination, pure and simple," said Laurie Flynn, executive director of the National Alliance for the Mentally Ill, one of several groups to release a new study on mental-health trends.
The report found spending for behavioral health fell 54 percent between 1988 and 1997, while total health-care spending fell by just 7 percent. In 1988, behavioral health care accounted for 6.1 percent of total health spending; by 1997, it was just 3.1 percent.
Most of the savings can be attributed to the rise of managed care, which requires patients to get permission before using health services and ratchets down payments to hospitals and doctors.
Much of the spending was appropriately eliminated as insurance companies took a close look at what was needed, said Dr. John Ludden, senior vice president of medical affairs for Harvard Pilgrim Health Care and a board member of the American Association of Health Plans, an HMO trade group.
New drugs have also led to new, less-expensive treatments, he said.
"We ought to be applauding the changes," he said. "Having people in mental hospitals less or in psychiatric hospitals less is in fact a triumph, not a problem."
It used to be that people were automatically admitted to the hospital for 28 days because the hospital could get paid for 28 days, said Roland Sturm, an economist who has studied mental-health benefits at the Rand Corp., a Santa Monica, Calif., think tank.
"There's been a lot of inefficiency," he said.
Ludden and Sturm agreed that restrictions on the number of visits are not necessary but said employers insisted on them to be sure that costs would not spiral as they had in the past.
A new law bars health insurance plans from the common practice of setting maximum coverage limits higher for physical ailments than for mental illnesses. In the face of opposition from employers and insurance companies, Congress rejected efforts to pass a stronger measure that would have required total parity for mental and physical health coverage.