Mental health services have for many years been the poor stepchildren in our healthcare system. Even families with “good” insurance often found to their dismay, when they needed it, that coverage of mental health problems was skimpy at best. Typically the total dollar coverage for all mental health services was capped at a fairly low number. Besides being unfair, even cruel, this practice makes little economic sense to our society; mental health problems are common, and untreated mental disorders lead to huge lost productivity.
We run into this problem from time to time in the PICU when we try to arrange care for children who need mental health care, such as depressed adolescents who attempt suicide (often by drug overdose) and end up in the PICU.
A major issue in getting parity in coverage is that the term “mental health problem” is quite broad, and specific disorders are sometimes difficult to define. The argument went that, if experts can’t agree on what something is, how can insurers be expected to pay for its treatment? The standard reference for defining mental health disorders is the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its 4th edition. The gamut of disorders this manual contains is wide, everything from severe schizophrenia to jet lag. Many insurers feared that granting parity to mental health claims would open a floodgate of trivial claims.
In fact, when mental health parity was allowed, this didn’t happen — the overwhelming majority of claims were for real, significant problems for which there is effective therapy. Once that became clear, insurers had no excuse any longer not to cover them. Congress recently passed a law requiring parity, but differences between House and Senate versions had the process stalled until a recent compromise.
03/25/2011 • I've written before about how poor children and children without health insurance are far more likely to need PICU care than are more affluent children. For example, although children on Medicaid account for 20 - ...more
08/27/2012 • As all of us know, there is a long, long tradition in our culture of disciplining or punishing children using physical means. "Spare the rod and spoil the child," as the old saying goes. That ...more
08/30/2010 • There's been a lot of attention, appropriate attention, focused on children without health insurance. These children tend to be in families with incomes too high to qualify for Medicaid, but too low to allow purchase ...more
Still another reason your insurance premiums go up: cost-shifting from public to private payers is getting worse and worse
10/24/2011 • A recent editorial in the New England Journal of Medicine makes an interesting contrast between the approaches public and private health plans have taken in controlling costs. It points out how governmental health programs -- ...more
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12/04/2013 • I've written about this before, but it's well worth doing it again. It's once more cold season, bringing up the question parents commonly face: Should they buy one of those rows and rows of cough, ...more
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08/29/2013 • I've written about this before, but it's always a good thing to remind ourselves of simple things in medicine. The severe-looking physician pictured above is Robert F. Loeb, long a professor at Columbia University Medical ...more
08/19/2013 • Many, myself included, have written about the overuse of head computed tomography (CT) scanning in children. This concern has become more focused now that we have some data on the radiation risk of those scans. ...more