The Mental Health Parity and Addiction Equity Act (MHPAEA) reduced the financial burden on families of children with mental illnesses, according to research published in Pediatrics.

Investigators extracted inpatient, outpatient, and pharmaceutical claims data from 3 national insurers between 2008 and 2012. Average annual mental health spending, inpatient and outpatient mental health visit frequency, and various out-of-pocket costs were captured for the years before (2008-2009) and after (2011-2012) parity as primary outcome measures. 

Researchers performed a difference-in-differences comparison for these measures between children enrolled in plans subject to parity under MHPAEA and children enrolled in plans not subject to parity. Logistic regression models were used to predict the influence of MHPAEA on the mental health service use and spending. Researchers controlled for various sociodemographic covariates, including sex, age, insurance type, state of residence, and diagnosis.

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According to difference-in-differences analyses, parity was associated with $140 lower average annual out-of-pocket mental health spending than projected from changes in the control group. Among those with high mental health spending, parity was associated with $234 lower average annual out-of-pocket mental health spending. Additionally, parity was also associated with a small increase of 0.5 inpatient mental health days per year among the highest spenders. Out-of-pocket mental health spending was $112 lower in the first year and $171 lower in the second year following parity legislation, relative to expected changes among all children. Among children spending the most on out-of-pocket medical expenses, costs were $210 lower in the first year after parity and $258 lower in the second year.

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MHPAEA enforcement was positively associated with lower spending for mental illness treatment among those with parity-associated policies. As such, MHPAEA provides financial protection to those with significant mental healthcare costs. However, given the proportion of patients without policies subject to parity, these study results may not be generalizable to the larger population of youth with mental illnesses.

Disclosure: Dr Epstein is an employee of Medicus Economics, LLC, a consulting firm with clients in the biopharmaceutical industry; the other authors have indicated they have no potential conflicts of interest to disclose.


Kennedy-Hendricks A, Epstein AJ, Stuart EA, et al. Federal parity and spending for mental illness. Pediatrics. 2018;142(2):e20172618.