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Parity laws appear to improve access to substance use disorder treatment


 

FROM JAMA PSYCHIATRY

The implementation of state-based parity legislation for specialty substance use disorder treatment is associated with significant improvements in access to treatment and treatment rates, new data show.

"These findings suggest that the [Mental Health Parity and Addiction Equity Act] of 2008 and the [Affordable Care Act] of 2010 hold the potential to improve access to [substance use disorder] treatment," wrote Hefei Wen of Emory University, Atlanta, and her colleagues. "Specialty SUD treatment services, such as outpatient psychosocial therapy and opioid maintenance therapy, have proved to be effective in improving health, reducing crime, increasing employment, and producing a wide range of social benefits."

The researchers used data from the National Survey of Substance Abuse Treatment Services, or N-SSATS, a database maintained by the Substance Abuse and Mental Health Services Administration that tracks all of the known specialty SUD treatment facilities in the United States.

N-SSATS defines specialty SUD facilities as "a hospital, a residential SUD facility, an outpatient SUD treatment facility, a mental health facility with an SUD treatment program, or other facility with an SUD treatment program" that provides numerous services (JAMA Psychiatry 2013 Oct. 23 [doi:10.1001/jamapsychiatry.2013.2169]).

In the past 2 decades, more than half of the states introduced SUD parity laws requiring employment-related group health plans to provide coverage for SUD treatment equal to that for comparable medical/surgical treatment.

The study found that implementation of any SUD parity law was associated with a 9% increase (P less than .001) in treatment rates in all specialty SUD treatment facilities, and a 15% increase (P= .02) in treatment rates at facilities accepting private insurance, according to data published online Oct. 23 in JAMA Psychiatry.

Ms. Wen and her associates also created three categories to distinguish between the levels of comprehensiveness in parity: full parity; partial parity, which that requires that SUD coverage be offered but allows for some discrepancies between SUD coverage and comparable medical or surgical coverage; and "parity-if-offered," in which SUD coverage is not required to be offered but if offered, should be on a par with comparable medical and surgical coverage.

If full parity or parity-if-offered were legislated, the treatment rates in all facilities climbed by 13% (P = .02) and 8% (P = .04), respectively. In facilities accepting private insurance, treatment rates rose by 21% (P = .03) and 10% (P = .04), respectively. "The influence of partial parity on the treatment rate was not statistically significant across models," the researchers wrote.

The researchers showed that among the 10 states that first implemented or extended SUD parity laws from 2000 to 2008, there was an 11% increase in the mean SUD treatment rate from the year immediately before parity laws were introduced to the first year after implementation. However, among states that did not change their SUD parity status, a 4% mean decrease was found in the treatment rate over the same period.

Ms. Wen and her associates cited a few limitations. For example, it was impossible to establish causality between the implementation of SUD parity laws and patients’ access to treatment. "However, the rigorous methods and robust results strongly suggest that parity improved access," they wrote.

No conflicts of interest disclosures were reported.

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