A review of studies of the impact of insurance on the demand and utilization of specialty mental health services.

Insurers and employers perceive the demand for mental health care to be highly responsive to the terms of insurance. Better coverage, it is believed, would increase demand, increasing expenditures through use of services that may be discretionary in nature. This article attempts to shed light on this issue by summarizing and evaluating the results of more than 40 published and unpublished studies. The major criterion for inclusion was the availability of information on the size of the population covered, so that rates of utilization could be calculated. More recent studies are emphasized. If research at the population level using aggregate utilization as a dependent variable is the "first generation of research," studies of individual use over a period of a year constitutes the "second generation." The emerging research on episodes of treatment represents a new "third generation" of studies. If some progress can be made on issues of ways in which patients form expectations about their treatment and its cost, this new generation of research promises to model demand response more precisely to coverage terms that change within a year, such as deductibles or limits.

[1]  R. Frank.  Pricing and Location of Physician Services in Mental Health , 1984, Economic inquiry.

[2]  W. Manning,et al.  Cost Sharing and the Demand for Ambulatory Mental Health Services , 1984 .

[3]  S. Sharfstein.  Financing Psychotherapy: Costs, Effects, and Public Policy , 1982 .

[4]  C E Phelps,et al.  Some interim results from a controlled trial of cost sharing in health insurance. , 1981, The New England journal of medicine.

[5]  C. D’Arcy,et al.  Psychiatric Health Care and Costs Under Comprehensive Public Health Insurance: Experience in a Canadian Province , 1981, Medical care.

[6]  T. Craig,et al.  A Comparison of Mental Health Costs and Utilization Under Three Insurance Models , 1981, Medical care.

[7]  J. Newhouse,et al.  On Having Your Cake and Eating It Too: Econometric Problems in Estimating the Demand for Health Services , 1980 .

[8]  P. Diehr,et al.  Mental Health Services: Utilization by Low Income Enrollees in a Prepaid Group Practice Plan and in an Independent Practice Plan , 1979, Medical care.

[9]  S. S. Goldensohn,et al.  Mental health services for Medicaid enrollees in a prepaid group practice plan. , 1979, The American journal of psychiatry.

[10]  W. W. Young,et al.  The Effects of Outpatient Psychiatric Utilization on the Costs of Providing Third-Party Coverage , 1978, Medical care.

[11]  C. D’Arcy.  Patterns in the Delivery of Psychiatric Care in Saskatchewan 1971–1972 (II): Types of Contacts and Some Patient Career Characteristics , 1977, Canadian Psychiatric Association journal.

[12]  C. D’Arcy.  Patterns in the Delivery of Psychiatric Care in Saskatchewan 1971–72: An Overview of Service Sectors and Patient Volumes , 1976, Canadian Psychiatric Association journal.

[13]  D. Freeborn,et al.  Use of mental health services by poverty and nonpoverty members of a prepaid group practice plan. , 1973, Health services reports.

[14]  D. Rice,et al.  Financing the care of the mentally ill under Medicare and Medicaid. , 1970, American journal of public health and the nation's health.

[15]  E. L. Green.  Psychiatric services in a California group health plan. , 1969, The American journal of psychiatry.

[16]  M. Glasser,et al.  Prepaid psychiatric are experience with UAW members. , 1969, The American journal of psychiatry.

[17]  P. Diehr,et al.  Factors related to the use of ambulatory mental health services in three provider plans. , 1986, Social science & medicine.

[18]  Willard G. Manning,et al.  The Demand for Episodes of Medical Treatment , 1982 .

[19]  S. Sharfstein,et al.  The Mental and Nervous Disorder Utilization and Cost Survey: an analysis of insurance for mental disorders. , 1980, The American journal of psychiatry.

[20]  J. Heckman.  Sample selection bias as a specification error , 1979 .

[21]  D. Neuhauser,et al.  The Role of Health Insurance in the Health Services Sector , 1977 .

[22]  D. Fullerton,et al.  Utilization of prepaid services by patients with psychiatric diagnoses. , 1976, The American journal of psychiatry.

[23]  F. Sloan.  Physician Fee Inflation: Evidence from the Late 1960s , 1976 .

[24]  J. Cohen,et al.  Mental health insurance: a comparison of a fee-for-service indemnity plan and a comprehensive mental health center. , 1972, The American journal of orthopsychiatry.