Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 1990 February; 24(6): 773–789.
PMCID: PMC1065600

Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.


The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.

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 (1.3M), 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.
  • Brook RH, Ware JE, Jr, Davies-Avery A, Stewart AL, Donald CA, Rogers WH, Williams KN, Johnston SA. Overview of adult health measures fielded in Rand's health insurance study. Med Care. 1979 Jul;17(7 Suppl):iii–131. [PubMed]
  • Hankin JR, Steinwachs DM, Elkes C. The impact on utilization of a copayment increase for ambulatory psychiatric care. Med Care. 1980 Aug;18(8):807–815. [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]
  • Hustead EC, Sharfstein SS. Utilization and cost of mental illness coverage in the Federal Employees Health Benefits Program, 1973. Am J Psychiatry. 1978 Mar;135(3):315–319. [PubMed]
  • Keeler EB, Manning WG, Wells KB. The demand for episodes of mental health services. J Health Econ. 1988 Dec;7(4):369–392. [PubMed]
  • Kessler LG, Steinwachs DM, Hankin JR. Episodes of psychiatric utilization. Med Care. 1980 Dec;18(12):1219–1227. [PubMed]
  • Manning WG, Jr, Wells KB, Benjamin B. Use of outpatient mental health services over time in a health maintenance organization and fee-for-service plans. Am J Psychiatry. 1987 Mar;144(3):283–287. [PubMed]
  • Manning WG, Jr, Wells KB, Duan N, Newhouse JP, Ware JE., Jr Cost sharing and the use of ambulatory mental health services. Am Psychol. 1984 Oct;39(10):1077–1089. [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]
  • Newhouse JP. A design for a health insurance experiment. Inquiry. 1974 Mar;11(1):5–27. [PubMed]
  • Reed LS. Utilization of care for mental disorders under the Blue Cross and Blue Shield plan for Federal employees, 1972. Am J Psychiatry. 1974 Sep;131(9):964–975. [PubMed]
  • Taube CA, Kessler LG, Burns BJ. Estimating the probability and level of ambulatory mental health services use. Health Serv Res. 1986 Jun;21(2 Pt 2):321–340. [PMC free article] [PubMed]
  • Wells KB, Manning WG, Jr, Duan N, Newhouse JP, Ware JE, Jr, Benjamin B. The sensitivity of mental health care use and cost estimates to methods effects. Med Care. 1984 Sep;22(9):783–788. [PubMed]
  • Wells KB, Manning WG, Jr, Duan N, Newhouse JP, Ware JE., Jr Use of outpatient mental health services by a general population with health insurance coverage. Hosp Community Psychiatry. 1986 Nov;37(11):1119–1125. [PubMed]

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