TABLE 2

Change in Mental Health Service Use and Spending Attributable to MHPAEA, 2008–2012

PreparityPostparityDifference-in-Difference Estimatea of Change Attributable to Parity (95% CI)
Children with mental health conditions (N = 69 233)
 Total mental health spending, $
  Exposed (self-insured)733169114 (−114 to 143)
  Comparison (small-group fully insured)7121656
 Total OOP mental health spending, $
  Exposed (self-insured)274543−140** (−196 to −84)
  Comparison (small-group fully insured)381790
 OOP share of total mental health spending, %
  Exposed (self-insured)44.441.61.3 (−0.4 to 3.0)
  Comparison (small-group fully insured)55.351.2
 No. outpatient mental health visits
  Exposed (self-insured)2.54.80.1 (−0.2 to 0.3)
  Comparison (small-group fully insured)2.44.6
 No. inpatient mental health days
  Exposed (self-insured)0.10.30.0 (−0.0 to 0.1)
  Comparison (small-group fully insured)0.10.3
 Total psychotropic medication spending, $
  Exposed (self-insured)280513−18 (−37 to 0)
  Comparison (small-group fully insured)283533
High spenders (N = 4292b)
 Total mental health spending, $
  Exposed (self-insured)53028708−311 (−1069 to 448)
  Comparison (small-group fully insured)54609177
 Total OOP mental health spending, $
  Exposed (self-insured)14392034−234** (−391 to −76)
  Comparison (small-group fully insured)21913019
 OOP share of total mental health spending, %
  Exposed (self-insured)31.429.60.6 (−2.0 to 3.2)
  Comparison (small-group fully insured)39.036.5
 No. outpatient mental health visits
  Exposed (self-insured)11.716.9−0.3 (−1.8 to 1.1)
  Comparison (small-group fully insured)11.216.7
 No. inpatient mental health days
  Exposed (self-insured)0.91.80.5* (0.1 to 0.9)
  Comparison (small-group fully insured)0.91.3
 Total psychotropic medication spending, $
  Exposed (self-insured)24573099−33 (−234 to 168)
  Comparison (small-group fully insured)24223097
  • ATT, average treatment effect on the treated.

  • a Difference-in-difference models estimate changes in outcomes between 2008–2009 (preparity) and 2011–2012 (postparity) between children exposed versus those unexposed to MHPAEA. All models estimates are doubly robust; we applied ATT weights and controlled for child demographic and health characteristics. SEs were adjusted to account for clustering within states.

  • b High spenders were the subset of children with mental health conditions who met or exceeded the 85th percentile in total mental health spending summed over 2008 and 2009 (pre-MHPAEA years) and in total mental health spending summed over 2011 and 2012 (post-MHPAEA years).

  • * P < .05.

  • ** P < .01.