OBJECTIVE: The authors examined the impact of increasing cost sharing on use of outpatient mental health services. METHOD: A quasi-experimental design was used to study outpatient utilization by members of a health maintenance organization (HMO) who were subject to increasing copayments for mental health visits (state government employees and dependents). Their outpatient mental health utilization was compared with that of similar HMO members who were not subject to cost sharing (federal government employees and dependents). Analyses compared both likelihood of any service use and number of visits per year among service users. RESULTS: Institution of $20/visit copayments was associated with a 16% decrease in likelihood of service use but no change in visit rate among service users. A subsequent copayment increase to $30/visit resulted in no significant change in likelihood of use but was associated with a 9% decrease in visits per year among those using services. The impact of the first copayment change on likelihood of using services did not vary according to level of clinical need (as measured by prior service use and psychotropic drug use). CONCLUSIONS: In this staff-model HMO, modest visit copayments significantly reduced initial access to mental health treatment and had a smaller effect on treatment intensity. Copayments restricted access regardless of clinical need. Designers of mental health benefits must consider the impact of copayments on those with the greatest need for treatment.
OBJECTIVE: The authors examined the impact of increasing cost sharing on use of outpatient mental health services. METHOD: A quasi-experimental design was used to study outpatient utilization by members of a health maintenance organization (HMO) who were subject to increasing copayments for mental health visits (state government employees and dependents). Their outpatient mental health utilization was compared with that of similar HMO members who were not subject to cost sharing (federal government employees and dependents). Analyses compared both likelihood of any service use and number of visits per year among service users. RESULTS: Institution of $20/visit copayments was associated with a 16% decrease in likelihood of service use but no change in visit rate among service users. A subsequent copayment increase to $30/visit resulted in no significant change in likelihood of use but was associated with a 9% decrease in visits per year among those using services. The impact of the first copayment change on likelihood of using services did not vary according to level of clinical need (as measured by prior service use and psychotropic drug use). CONCLUSIONS: In this staff-model HMO, modest visit copayments significantly reduced initial access to mental health treatment and had a smaller effect on treatment intensity. Copayments restricted access regardless of clinical need. Designers of mental health benefits must consider the impact of copayments on those with the greatest need for treatment.
Authors: Constance M Horgan; Deborah W Garnick; Elizabeth Levy Merrick; Dominic Hodgkin Journal: J Behav Health Serv Res Date: 2007-09-14 Impact factor: 1.505
Authors: Paul A Fishman; Victoria Ding; Rebecca Hubbard; Evette J Ludman; Chester Pabiniak; Christine Stewart; Leo Morales; Gregory E Simon Journal: Health Serv Res Date: 2012-02-29 Impact factor: 3.402
Authors: Paul N Pfeiffer; Michele Heisler; John D Piette; Mary A M Rogers; Marcia Valenstein Journal: Gen Hosp Psychiatry Date: 2010-11-13 Impact factor: 3.238
Authors: Joseph E Glass; Brian E Perron; Mark A Ilgen; Stephen T Chermack; Scott Ratliff; Kara Zivin Journal: Drug Alcohol Depend Date: 2010-07-24 Impact factor: 4.492
Authors: Carol A Janney; Caroline R Richardson; Robert G Holleman; Cristie Glasheen; Scott J Strath; Molly B Conroy; Andrea M Kriska Journal: Ment Health Phys Act Date: 2008-06-01