Mental health parity: what are the gaps in coverage?

BACKGROUND: Mental health benefits in private health insurance plans in the United States are typically less generous than benefits for physical health care services, driving reform efforts to achieve parity in coverage. While there is growing evidence about the effects such legislation would have on the utilization and cost of mental health services, less is known about the impact parity would have on reducing the risk of large out-of-pocket expenses that families would face in the event of mental illness. AIMS OF THE STUDY: We seek to understand the impact that mental health parity would have on the out-of-pocket burden that families would face in the event of mental illness. We focus in particular on variations in coverage across the privately insured population. METHODS: We compare out-of-pocket spending for hypothetical episodes of mental health treatment, first under current insurance coverage in the United States and then under a reform policy of full mental health parity. We exploit detailed informtion on actual health plan benefits using a nationally-representative sample of the privately insured population under age 65 from the 1987 National Medical Expenditure Survey (NMES) that has been carefully aged and reweighted to represent 1995 population and benefit characteristics. RESULTS: Our results show that existing benefits of the U.S. privately insured population under age 65 leave most people at risk of high out-of-pocket costs in the event of a serious mental illness. Moreover, the generosity of existing mental health benefits varies widely across subgroups, particularly across firm size. We find significantly lower out-of-pocket costs when simulating full parity coverage. However, our results show those with less generous mental health coverage tend to have less generous physical health coverage, as well. CONCLUSIONS: Parity would substantially increase generosity of mental health coverage for most of the privately insured population. The wide variation in the generosity of existing mental health benefits suggests that there are likely to be differential impacts from a parity mandate. Those with limited physical health coverage would still be at significant financial risk for catastrophic mental illness.     

The HBSC study in Scotland: can the study influence policy and practice in schools?

This paper reviews the role of the HBSC study in Scotland and suggests that the HBSC study has growing status and relevance in Scotland for a number of reasons as it continues to provide insights for politicians, policy makers, education professionals and health promotion practitioners. The paper will set out the historical background to the HBSC study and the associated research and health promoting school developments in Scotland. It will explore the factors that have been important in its influential role in contributing to health promotion policy developments in the education and health sectors in Scotland. It is suggested that this role has been shaped by:

Hepatitis A virus in surface water in South Africa: what are the risks?

The aim of this study was to assess the potential risk of infection constituted by HAV to persons using surface dam and river water for domestic and recreational purposes. It estimates the potential risk using a deterministic exponential risk assessment model with mean values and conservative assumptions. Hepatitis A virus was detected in 17.5% of river and 14.9% of dam water samples tested. The number of indicator organisms in these sources exceeded drinking and recreational water quality guidelines set by the United States Environmental Protection Agency (US EPA), indicating possible health risks to recreational water users. Based on the available data and taking all the assumptions into consideration, the probability of infection (Pinf) to the higher socio-economic population using the river water for recreational purposes was 1.1 x 10(-3) per day and 3.3 x 10(-1) per annum if 100 ml was ingested per day. For recreation in the dam water the Pinf value was 1.2 x 10(-4) per day and 4.2 x 10(-2) per annum. For the lower socio-economic population, risk values for drinking purposes (2 L day(-1)) were ten-fold greater. These surface waters therefore did not conform to the US EPA guidelines of 1 infection per 10,000 consumers per year for drinking water or eight gastrointestinal illnesses per 1,000 bathers per day in environmental waters used for recreational purposes. This is the first risk assessment study addressing the risk of infection by HAV in surface water to different socio-economic populations in South Africa.     

Vegetarianism and weight status: What are the differences in eating styles,impulsivity, and emotional competences? A preliminary study

Recent studies suggest that vegetarian diets may be recommended to promote weight loss in individuals living with obesity. However, limited studies have examined psychological factors (e.g., eating styles, impulsivity) among individuals who have adopted this type of diet, even though these factors are known to play a role in being overweight. The primary objective of the present study was to compare these characteristics in participants living with obesity or those with normal-weight across diet types. Participants were recruited from two hospital nutrition departments and the general population. They completed a diagnostic interview assessing the presence of an eating disorder, followed by self-administered questionnaires measuring dysfunctional eating styles (DEBQ), impulsivity (UPPS), and emotional competence (PEC). Vegetarian participants living with obesity engaged in more dysfunctional eating styles than did normal-weight omnivores and experienced more emotional difficulties than did both normal-weight omnivores and vegetarians. In contrast, there were no significant differences between omnivore participants living with obesity and those in the other groups. Moreover, participants living with obesity had comparable emotion regulation abilities to normal-weight participants. These results suggest that emotion regulation deficits can more likely be explained by the presence of psychopathological traits than by being overweight or one’s choice of diet.     

Pedophile, who are you? A study of pedophilia in the press

This paper define the characteristics of pedophilia as it appears in the Brazilian newspaper Folha de S?o Paulo, including both the characteristics of the pedophile and the reasons given for such behavior. The research employs a technique called analysis by opposition which means that news coverage on other forms of sexual violence against children (sexual abuse, child pornography, rape, and incest) is used to help shed light on the characteristics of pedophilia itself. Some 384 articles were analyzed, of which 114 referred to pedophilia, all published between 1994 and 1999. News on sexual abuse of children was biased by concepts of class and violence/illness, reiterating the lay view that violence can be either a result of barbarianism and poverty or of psychological disorder, both depending on the aggressor's social class. The theoretical perspective adopted, that there is a correlation between media and reality, indicates that this bias is shared by Brazilian society as a whole.     

Globalisation,rural restructuring and health service delivery in Australia: policy failure and the role of social work?

The impacts of globalisation and rural restructuring on health service delivery in rural Australia have been significant. In the present paper, it is argued that declining health service access represents a failure of policy. Rural communities across the world are in a state of flux, and Australia is no different: rural communities are ageing at faster rates than urban communities and young people are out-migrating in large numbers. During the past 5 years, rural Australia has also experienced a severe and widespread drought that has exacerbated rural poverty, and impacted on the health and well-being of rural Australians. Australian governments have responded to globalising forces by introducing neoliberal policy initiatives favouring market solutions and championing the need for self-reliance among citizens. The result for rural Australia has been a withdrawal of services at a time of increased need. This paper addresses the social work response to these changes.     

Respiratory illness in the Dominican Republic: what are the predictors for health services utilization of young children?

Respiratory illness and diarrhoea continue to be the leading causes of paediatric morbidity and mortality in the Dominican Republic. An important first step in alleviating this disease burden is to understand patterns and predictors of health services utilization for these conditions. This study examines the predictors of (a) health services utilization, and (b) public versus private sector use, for respiratory illness in the under-five population in the Dominican Republic. The DHS-2 dataset (1991) was utilized for analysis. Logistic regression models for predicting use and non-use, and for predicting private versus public sector use, were constructed using the Andersen Behavioural Model as the conceptual framework. Our findings indicate that sex, location and possession index quartile are factors that influence the decision to seek care or not for respiratory illness in under-fives. In contrast, the choice between the public and private sector is determined by location and insurance status. From the policy perspective, if the Dominican Republic were to undertake steps to increase private insurance coverage, our results indicate that this would lead to increased utilization of private sector providers for respiratory illness by children having private insurance, but would not have an impact on overall utilization (i.e. use vs. non-use). On the other hand, one of the ways to deliver cost-effective interventions by the publicly financed system would be to improve facilities in the rural areas.     

Cardiology services after stress testing: are there sex differences? A population-based study

To test the hypothesis that, in a population-based cohort of persons undergoing stress tests, female sex was negatively associated with the use of cardiology visits in persons with no documented coronary artery disease (CAD) but that this association did not exist when CAD was established. Sex differences in the use of invasive cardiac procedures have been clearly documented, but data on physician encounters, an integral part of care, are lacking. A population-based cohort consisting of all Olmsted County, Minnesota residents who underwent an initial stress test in 1987, 1988, and 1989 in Olmsted County was examined. Medical records were reviewed for baseline characteristics including CAD diagnosis status, test results, and cardiology visits in the year following the stress test. Regression models were constructed to determine whether sex is independently associated with the probability of a visit. In the year after stress testing, there was no difference between the sexes in the use of inpatient (OR for female sex 0.88, 95% CI 0.62-0.97, P = 0.365) and outpatient/consultative (OR for female sex 1.24, 95% CI 0.95-1.61, P = 0.6) cardiology visits. Women were, however, less likely to receive preventive cardiology visits (OR for female sex 0.77, 95% CI 0.62-0.97, P = 0.02). This was largely related to less use of preventive visits among older women with documented coronary artery disease (CAD). In the absence of documented CAD, when the stress test was positive, women were less likely to receive preventive visits. In this geographically defined population within one year after an initial stress test, there was no sex difference in the use of in-patient or out-patient visits but women were less likely to receive preventive cardiology visits in the year after stress testing. Further studies are needed to understand the reasons for and impact of these care patterns.     

Cross-border issues in the provision of health services: are we moving towards a European health care policy?

This paper analyses likely implications of two recent European Court rulings on the provision of health care across borders within the European Union. We argue that the two cases have fundamental implications for the provision of health services as free access to care across borders conflicts with the principle of subsidiarity. We then explore the potential short- and long-term implications of the two cases for all involved in the provision of health services, namely patients, different types of purchasers and different types of providers. We argue that the short-term implications relating to freedom to provide goods and services may lead to re-thinking how services are financed and provided. At the same time, the rulings may lead to greater transparency in health services, with attempts to compare efficiency and prices between providers in different countries. Consumers may benefit directly by gaining access to a product or service that is not available in their country of residence or is available but at a higher cost or lower quality. They may also benefit indirectly in the long term, through greater transparency and efficiency.     

Medical services in urban China: does the 'free' care policy induce greater demand?

In this paper we discuss the nature of the medical services and the free medical care programs in urban China, then using the data collected in a large city, we also explored the differences between those covered by a free program and those not in perceived illness, doctor visit, hospital admission, and emergency use. Our findings may show that Chinese experience in medical service use is consistent with the common idea that a free medical care policy could induce greater demand while it also has its own nature.     

Paying for and receiving benefits from health services in South Africa: is the health system equitable?

There is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed 'partial' analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.     

Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia

A prospective cohort study, involving 141 Anglo-Celts and 189 Greek-Australians of both sexes aged 70 years or more, was undertaken in Melbourne, Australia. The objective was to evaluate whether adherence to the principles of the Mediterranean diet affects survival of elderly people in developed non-Mediterranean countries. Diet was assessed using an extensive validated questionnaire on food intake. A one unit increase in a diet score, devised a priori on the basis of eight key features of the traditional common diet in the Mediterranean region, was associated with a 17% reduction in overall mortality (two-tailed P value 0.07). Mortality reduction with increasing diet score was at least as evident among Anglo-Celts as among Greek-Australians. We conclude that a diet that adheres to the principles of the traditional Mediterranean diet is associated with longer survival among Australians of either Greek or Anglo-Celtic origin.