The Role of Behavioral Health Diagnoses in Adverse Selection
- 1 September 2020
- journal article
- research article
- Published by American Psychiatric Association Publishing in Psychiatric Services
- Vol. 71 (9), 920-927
- https://doi.org/10.1176/appi.ps.201900354
Abstract
Objective: Adverse selection in medical insurance is well documented; however, little is known about the role of behavioral health. This study’s objective was to examine the probability of being enrolled in the lowest-deductible plan among commercially insured patients, according to psychiatric diagnosis. Methods: This cross-sectional study used 2012–2013 benefit design and plan choice data linked to 2011–2012 behavioral health claims for a national sample of individuals (N=116,975) and different family types (couple with at least one dependent, N=59,237; single subscriber with at least one dependent, N=19,066; couple with no dependents, N=40,917) with Optum, UnitedHealth Group “carve-in” plans. Analyses included multiple logistic regressions examining whether the individual (or family) was enrolled in the plan with the lowest deductible as functions of whether individuals (or family members) had any psychiatric diagnosis, the number of psychiatric diagnoses they had, and whether they had individual major psychiatric diagnoses. Results: For individuals, having any psychiatric diagnosis was associated with an increase of about 10% in the probability of being enrolled in the lowest-deductible plan compared with having no psychiatric diagnosis (44.9% vs. 40.7%, p=0.04). Each additional psychiatric diagnosis increased this probability by three percentage points (p=0.02). A diagnosis of depression was associated with the largest increase. Conclusions: When individuals were offered the choice of a health insurance plan, having a prior psychiatric diagnosis (specifically depression) was associated with being enrolled in the lowest-deductible plans. Individuals with depression may anticipate future expenditures and select plans accordingly.Keywords
This publication has 19 references indexed in Scilit:
- Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use CoverageHealth Affairs, 2016
- Using Drugs to Discriminate — Adverse Selection in the Insurance MarketplaceThe New England Journal of Medicine, 2015
- Does service-level spending show evidence of selection across health plan types?Applied Economics, 2013
- Regulating a Health Insurance Exchange: Implications for Individuals With Mental IllnessPsychiatric Services, 2010
- Mental health and substance abuse insurance parity for federal employees: How did health plans respond?Journal of Policy Analysis and Management, 2007
- The Magnitude and Nature of Risk Selection in Employer-Sponsored Health PlansHealth Services Research, 2004
- Multiple Prior Years of Health Expenditures and Medicare Health Plan ChoiceInternational Journal of Health Economics and Management, 2004
- The Effect of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare ProgramHealth Services Research, 2004
- Understanding Biased Selection in Medicare HMOsHealth Services Research, 2003
- The demand for deductibles in private health insurance: A probit model with sample selectionJournal of Econometrics, 1981