Mental health, substance abuse and parity law Essay

            Parity law is the law that requires the insurance company that an individual uses to cover him or her in case of mental health or substance abuse services at a cost equal to that of the other health services offered by the same company (Sing M., Hill S., Smolkin S. & Heiser N. 1998). In the course of this paper, the discussion will focus on the benefits of parity law and the problem it aims at rectifying. It will also look at the importance of the law in the United States of America while comparing it with other countries that offer universal health coverage. This will be done to ascertain whether or not the problem is unique to the United States.

            Health insurers and healthcare service plans discriminate against those suffering from mental illnesses and substance abuse. They tend to focus more on those suffering from physical disorders and other diseases that are connected to the physical wellbeing of an individual. In most cases if one wants to be covered for mental disorders of any kind and substance abuse, an extra charge is required by the insurance company and this is what the parity law intends to correct. The law requires that all forms of illness whether physical or mental should all have similar benefits with the charges that the individuals pay being equal.

            Prior to the introduction of the parity law, insurance companies would leave the people suffering from any type of mental illness to cater for themselves when they became ill. One would find that he or she has a medical cover but it does not cover all forms of illness thus leaving them stranded when they required medical assistance. Those who had mental disorders were forced to either pay extra money to the insurance company or to use their own resources when getting medical services at the health facilities. This would more often than not lead to the inability of individuals to gain access to treatment because it was unaffordable to them yet they had an insurance cover.

            Another problem is related to the covering of certain mental problems while neglecting others. The health insurers would cover only certain illnesses while completely ignoring others. Furthermore even those that were covered had certain limitation that made it less effective than it was supposed to be. Other than the separate and unequal charges imposed on these individuals, there were also limits on the yearly and lifetime visits that one could make and if these number was exceeded then the company was under no obligation to cover for the extra visits. There was also a limit on the amount of money that could be spent on such illnesses thus making it possible for an individual to have the treatment stopped since the amount of money has exceeded that which can be paid by the insurance company (Sturm R. & Pacula R. 1999).

            The parity law also requires that if any out-of-network benefits are provided for the people suffering from physical disorders, they should also be made available to those suffering from mental disorders and substance abuse. Also, if the insurance plan that one is using has more than one benefit package, then the law applies separately to both packages and one may not be charged extra for the inclusion of the mental and substance abuse disorders. Either of the two packages will be used to cater for any health services that are required by the insured individual without reference to the other (Sing M., Hill S., Smolkin S. & Heiser N. 1998).

            In case the insurance company defaults in delivery of the services promised, it is required by the law to give an explanation concerning its course of action. This then means that an insurance company cannot refuse to make payments for the person as long as that person is eligible to get the payments. Failure to do must be accompanied by a plausible explanation that can be accepted by both the insured individual and a court of law in case the individual decides to pursue the matter using legal measures. This is a benefit to the insured people because it means that their insurance companies do not defraud them of the services that they are required to give regardless of the illness that they may be suffering from.

            Although the parity law is different depending on which state it is being applied in, the fundamentals of the law are still applicable in whichever state one may be in. The parity laws introduced in 1996 already limit the amount of dollars that one is required to pay annually and also in one’s lifetime to an insurance company. This cannot be changed regardless of the state where the law is being applied and thus it assists in making health care accessible to all people despite the state that one is in. each state however is allowed to make the changes that it may find necessary to the law so as to make it possible to apply the law to its people (Sturm R. & Pacula R. 1999).

            Of all the developed and industrialized countries, the United States is the only one that does not offer universal health coverage (Shi L. & Stevens G. D. 2004). Some of the developing countries are also starting to adopt the system. The universal health care coverage caters for medical, mental and dental health care. It is usually accomplished through the use of national health insurance or a single-payer health care system. Just like the parity laws in the United States, the application of this form of health insurance depend on the country in which they are being applied. Each country has its own form of universal health coverage although the fundamentals are similar in providing medical care to all eligible citizens.

            The universal health care is similar in all countries on account of government involvement in all the activities that take place. This may be done through taxation, legislation and regulation. It is made into a law that all people must participate in the contribution towards health care and this makes it possible for the government to ensure that as many people as possible in the country can afford to access health care. The government is then able to direct who should receive what treatment and the basis of the treatment that each individual is to receive. This can only be done through legislation and regulation.

            It is however important to note that not all costs are catered for by the health insurance. Some of the costs albeit minimal are left for the patient to pay for them but the majority of the costs are catered for by the health care program. The money used to pay for the health care comes from different sectors depending on the specific program that a country uses. Some countries prefer to get the money from tax revenues alone while others prefer to combine it with compulsory insurance that is deducted from every individual’s income. Despite where the money for healthcare comes from, the important thing is that it is able to provide affordable health care services to all people regardless of the illness that the individual may be suffering from (Shi L. & Stevens G. D. 2004).

            In some cases, the government is able to manage all the health related services required including the health care centers where people can go for treatment. However, others prefer using a hybrid of private and public systems to provide healthcare. When using the mixture of private and public, it depends on the country in question how the services will be divided between the public and private sector. Some prefer to use government facilities with private doctors who are paid depending on the number of patients that they see instead of having an annual fee. Others do not have a problem with people visiting private doctors but regulate the amount of money that one should pay for the services rendered.

            However, it is important to realize that the entire medical care is not covered and individuals have to cater for some of the things that are not covered or provided. This may include prescription drugs which may not be available and one may be forced to purchase from private pharmacies. Such costs may not be covered by the healthcare program and hence are pushed to the individual. This depends on the country because some may not even provide dental and visual services hence leaving the individual to cater for them. For mental and substance abuse however the costs of the treatment required is catered for by the government and hence the cost of such illnesses are lifted from the people allowing them to gain access to proper healthcare in a timely manner.

            When comparing the universal health care with the form of health care offered by insurance companies in America, it seems that the universal health care is much better and is preferable (Shi L. & Stevens G. D. 2004). However, with the use of parity law that emphasizes on the use of one insurance cover to cater for both physical and mental illnesses at the same price without extra payments demanded, the American health care system is bound to improve. The American health care system is negatively affected by the ability of the insurance companies to pick who they want to insure and which diseases and disorders they will insure. The parity law however equalizes everyone making it the only way to ensure that all Americans are able to obtain good health at affordable rates (Sing M., Hill S., Smolkin S. & Heiser N. 1998).

            In conclusion, one is able to say that the American health care system has numerous flaws especially when it comes to dealing with the mental disorders and substance abuse. This is mostly as a result of the discrimination that individuals suffering from these ailments suffer at the hands of the insurance companies. With the introduction of the parity law, the insurance companies will be forced by law to insure everyone despite their illness and also honor the contracts that they get into unless the reasons for not doing so are acceptable and understood by all the parties involved. With the adoption of the parity law, all Americans will be able to get the right treatment when it is needed leading to a healthier nation.

References

1.      Shi L. & Stevens G. D. 2004, Vulnerable Populations in the United States, John Wiley & Sons, 989 Market Street San Francisco

2.      Sing M., Hill S., Smolkin S. & Heiser N. 1998, Costs and Effects of Parity for Mental Health and Substance Abuse Insurance Benefits Retrieved on 20th February 2009 from                                                                                  http://mentalhealth.samhsa.gov/

3.      Sturm R. & Pacula R. 1999, State Mental Health Parity Laws: Cause or Consequences of Differences in Use?, Health Affairs Vol. 18 Issue 5, Project Hope