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. 1987 Apr;22(1):1–17.

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

K B Wells, W G Manning Jr, N Duan, J P Newhouse, J E Ware Jr
PMCID: PMC1065420  PMID: 3106267

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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brook R. H., Davies-Avery A., Greenfield S., Harris L. J., Lelah T., Solomon N. E., Ware J. E., 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] [Google Scholar]
  2. Brook R. H., Ware J. E., Jr, Rogers W. H., Keeler E. B., Davies A. R., Donald C. A., Goldberg G. A., Lohr K. N., Masthay P. C., Newhouse J. P. Does free care improve adults' health? Results from a randomized controlled trial. N Engl J Med. 1983 Dec 8;309(23):1426–1434. doi: 10.1056/NEJM198312083092305. [DOI] [PubMed] [Google Scholar]
  3. Colle A. D., Grossman M. Determinants of pediatric care utilization. J Hum Resour. 1978;13 (Suppl):115–158. [PubMed] [Google Scholar]
  4. Dutton D. B. Patterns of ambulatory health care in five different delivery systems. Med Care. 1979 Mar;17(3):221–243. doi: 10.1097/00005650-197903000-00001. [DOI] [PubMed] [Google Scholar]
  5. Eastaugh S. R. Limitations on quality assurance effectiveness: Improving psychiatric inpatient drug prescribing habits of physicians. J Med Syst. 1980;4(1):27–43. doi: 10.1007/BF02222821. [DOI] [PubMed] [Google Scholar]
  6. Gullick E. L., King L. J. Appropriateness of drugs prescribed by primary care physicians for depressed outpatients. J Affect Disord. 1979 Mar;1(1):55–58. doi: 10.1016/0165-0327(79)90024-7. [DOI] [PubMed] [Google Scholar]
  7. Horgan C. M. Specialty and general ambulatory mental health services. Comparison of utilization and expenditures. Arch Gen Psychiatry. 1985 Jun;42(6):565–572. doi: 10.1001/archpsyc.1985.01790290047005. [DOI] [PubMed] [Google Scholar]
  8. Horgan C. M. 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] [Google Scholar]
  9. Johnson D. A. Treatment of depression in general practice. Br Med J. 1973 Apr 7;2(5857):18–20. doi: 10.1136/bmj.2.5857.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Liptzin B., Regier D. A., Goldberg I. D. Utilization of health and mental health services in a large insured population. Am J Psychiatry. 1980 May;137(5):553–558. doi: 10.1176/ajp.137.5.553. [DOI] [PubMed] [Google Scholar]
  11. Manning W. G., Jr, Wells K. B., Duan N., Newhouse J. P., Ware J. E., Jr How cost sharing affects the use of ambulatory mental health services. JAMA. 1986 Oct 10;256(14):1930–1934. [PubMed] [Google Scholar]
  12. Newhouse J. P., Manning W. G., Morris C. N., Orr L. L., Duan N., Keeler E. B., Leibowitz A., Marquis K. H., Marquis M. S., Phelps C. E. Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med. 1981 Dec 17;305(25):1501–1507. doi: 10.1056/NEJM198112173052504. [DOI] [PubMed] [Google Scholar]
  13. Regier D. A., Goldberg I. D., Taube C. A. The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry. 1978 Jun;35(6):685–693. doi: 10.1001/archpsyc.1978.01770300027002. [DOI] [PubMed] [Google Scholar]
  14. Schurman R. A., Kramer P. D., Mitchell J. B. The hidden mental health network. Treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiatry. 1985 Jan;42(1):89–94. doi: 10.1001/archpsyc.1985.01790240091010. [DOI] [PubMed] [Google Scholar]
  15. Schurman R. A., Kramer P. D., Mitchell J. B. The hidden mental health network. Treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiatry. 1985 Jan;42(1):89–94. doi: 10.1001/archpsyc.1985.01790240091010. [DOI] [PubMed] [Google Scholar]
  16. Shapiro S., Skinner E. A., Kessler L. G., Von Korff M., German P. S., Tischler G. L., Leaf P. J., Benham L., Cottler L., Regier D. A. Utilization of health and mental health services. Three Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1984 Oct;41(10):971–978. doi: 10.1001/archpsyc.1984.01790210053007. [DOI] [PubMed] [Google Scholar]
  17. Sloan F. A. The demand for physicians' services in alternative practice settings: a multiple logit analysis. Q Rev Econ Bus. 1978 Spring;18(1):41–61. [PubMed] [Google Scholar]
  18. Ware J. E., Jr, Manning W. G., Jr, Duan N., Wells K. B., Newhouse J. P. Health status and the use of outpatient mental health services. Am Psychol. 1984 Oct;39(10):1090–1100. doi: 10.1037//0003-066x.39.10.1090. [DOI] [PubMed] [Google Scholar]
  19. Ware J. E., Jr, Manning W. G., Jr, Duan N., Wells K. B., Newhouse J. P. Health status and the use of outpatient mental health services. Am Psychol. 1984 Oct;39(10):1090–1100. doi: 10.1037//0003-066x.39.10.1090. [DOI] [PubMed] [Google Scholar]
  20. Watts C. A., Scheffler R. M., Jewell N. P. 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] [Google Scholar]

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