PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 1987 April; 22(1): 1–17.
PMCID: PMC1065420

Cost-sharing and the use of general medical physicians for outpatient mental health care.

Abstract

Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Regier DA, Goldberg ID, Taube CA. The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry. 1978 Jun;35(6):685–693. [PubMed]
  • Schurman RA, Kramer PD, Mitchell JB. The hidden mental health network. Treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiatry. 1985 Jan;42(1):89–94. [PubMed]
  • Shapiro S, Skinner EA, Kessler LG, Von Korff M, German PS, Tischler GL, Leaf PJ, Benham L, Cottler L, Regier DA. Utilization of health and mental health services. Three Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1984 Oct;41(10):971–978. [PubMed]
  • Liptzin B, Regier DA, Goldberg ID. Utilization of health and mental health services in a large insured population. Am J Psychiatry. 1980 May;137(5):553–558. [PubMed]
  • Ware JE, Jr, Manning WG, Jr, Duan N, Wells KB, Newhouse JP. Health status and the use of outpatient mental health services. Am Psychol. 1984 Oct;39(10):1090–1100. [PubMed]
  • Manning WG, Jr, Wells KB, Duan N, Newhouse JP, Ware JE., Jr How cost sharing affects the use of ambulatory mental health services. JAMA. 1986 Oct 10;256(14):1930–1934. [PubMed]
  • Watts CA, Scheffler RM, Jewell NP. Demand for outpatient mental health services in a heavily insured population: the case of the Blue Cross and Blue Shield Association's Federal Employees Health Benefits Program. Health Serv Res. 1986 Jun;21(2 Pt 2):267–289. [PMC free article] [PubMed]
  • Horgan CM. The demand for ambulatory mental health services from specialty providers. Health Serv Res. 1986 Jun;21(2 Pt 2):291–319. [PMC free article] [PubMed]
  • Sloan FA. The demand for physicians' services in alternative practice settings: a multiple logit analysis. Q Rev Econ Bus. 1978 Spring;18(1):41–61. [PubMed]
  • Dutton DB. Patterns of ambulatory health care in five different delivery systems. Med Care. 1979 Mar;17(3):221–243. [PubMed]
  • Colle AD, Grossman M. Determinants of pediatric care utilization. J Hum Resour. 1978;13 (Suppl):115–158. [PubMed]
  • Newhouse JP, Manning WG, Morris CN, Orr LL, Duan N, Keeler EB, Leibowitz A, Marquis KH, Marquis MS, Phelps CE, et al. Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med. 1981 Dec 17;305(25):1501–1507. [PubMed]
  • Ware JE, Jr, Manning WG, Jr, Duan N, Wells KB, Newhouse JP. Health status and the use of outpatient mental health services. Am Psychol. 1984 Oct;39(10):1090–1100. [PubMed]
  • Brook RH, Davies-Avery A, Greenfield S, Harris LJ, Lelah T, Solomon NE, Ware JE., Jr Assessing the quality of medical care using outcome measures: an overview of the method. Med Care. 1977 Sep;15(9 Suppl):suppl–165. [PubMed]
  • Schurman RA, Kramer PD, Mitchell JB. The hidden mental health network. Treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiatry. 1985 Jan;42(1):89–94. [PubMed]
  • Horgan CM. Specialty and general ambulatory mental health services. Comparison of utilization and expenditures. Arch Gen Psychiatry. 1985 Jun;42(6):565–572. [PubMed]
  • Eastaugh SR. Limitations on quality assurance effectiveness: Improving psychiatric inpatient drug prescribing habits of physicians. J Med Syst. 1980;4(1):27–43. [PubMed]
  • Gullick EL, King LJ. Appropriateness of drugs prescribed by primary care physicians for depressed outpatients. J Affect Disord. 1979 Mar;1(1):55–58. [PubMed]
  • Johnson DA. Treatment of depression in general practice. Br Med J. 1973 Apr 7;2(5857):18–20. [PMC free article] [PubMed]
  • Brook RH, Ware JE, Jr, Rogers WH, Keeler EB, Davies AR, Donald CA, Goldberg GA, Lohr KN, Masthay PC, Newhouse JP. Does free care improve adults' health? Results from a randomized controlled trial. N Engl J Med. 1983 Dec 8;309(23):1426–1434. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust