Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report. Evaluation Design and Key Research Questions

12/31/2004

The design of the evaluation was quasi-experimental. It analyzed plan benefits data for all FEHB plans and claims data on access, utilization, and cost for a subset of nine FEHB plans, both before (1999 and 2000) and after (2001 and 2002) the introduction of FEHB parity. Changes in access, utilization and cost were compared to changes in a matched set of non-FEHB comparison plans. For the subset of plans selected for in-depth study, case studies on the implementation of the parity policy were prepared based on a site visit to each selected plan.

The key research questions on how the FEHB parity policy was implemented and the impact of the policy are shown below.

Implementation Key Research Questions

  • Did all FEHB plans comply with the parity policy?
  • How did the FEHB parity policy affect MH/SA benefit design and management?
  • How did the FEHB parity policy affect the benefit design and management for general medical care?
  • Did FEHB plans incur additional expenses in implementing the parity policy?
  • How did providers experience the FEHB parity policy?

Impact Key Research Questions

  • How did the parity policy affect access to and utilization of MH/SA care?
  • How did the parity policy affect cost of MH/SA care to the beneficiary and OPM?
  • How did any changes in these areas compare to secular trends?
  • How did the parity policy affect utilization and spending on medications for MH/SA disorders?
  • Was quality of care affected by the parity policy?

Plan Selection

FEHB plans were selected for in-depth study on the basis of various characteristics on which they were likely to differ, i.e., geographic location; the breadth of parity in State law; differences in plan type and structure (e.g., health maintenance organization [HMO], point of service [POS], or fee-for-service (FFS) with a preferred provider option [PPO]); size of the enrollee population; and the plan’s interest in collaborating on the evaluation. The nine selected plans represent over 3.2 million FEHB beneficiaries.

Limitations of the Study

The evaluation is limited in several ways. First, the study design was not experimental, so it is more difficult to attribute all of the effects to parity rather than the secular trend in MH/SA care generally. However, the matched non-FEHB comparison group diminished this threat considerably. Second, while the effect of State parity laws may have mitigated the impact of the FEHB parity policy, the FEHB parity policy is actually substantially broader than nearly all State parity regulations. Finally, generalizations from these selected plans to all FEHB plans must be made cautiously.

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