Am J Psychiatry 1991; 148:96-101
Copyright © 1991 by American Psychiatric Association
How do HMOs reduce outpatient mental health care costs?
GS Norquist and KB Wells
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine.
OBJECTIVE: Because previous studies of differences in utilization of mental
health care services have had important limitations, it is not clear if
their findings that health maintenance organization (HMO) outpatient mental
health care costs less than fee-for-service care are due to less access,
less intensive care per user, or selective enrollment of healthier people
by HMOs. Therefore, the authors used data from the National Institute of
Mental Health Epidemiologic Catchment Area (ECA) study to examine
differences in the prevalence of psychiatric disorder and differences in
the use of outpatient mental health services for adults enrolled in HMO or
fee-for-service health insurance plans. METHOD: The subjects were an ECA
community sample obtained from East Los Angeles and West Los Angeles. This
sample included a large number of Hispanic subjects. The subjects were
categorized according to their responses to a 5-item battery on insurance
as Medicare enrolles, members of private fee-for-service plans, Medicaid
enrollees, members of an HMO, and uninsured. The presence or absence of
psychiatric disorders was determined by using the NIMH Diagnostic Interview
Schedule. Both users and nonusers of mental health services were studied.
RESULTS: The HMO and fee-for- service plans had similar prevalence of
psychiatric disorder and similar access to specialty mental health care.
However, HMO enrollees had significantly fewer visits per user to providers
of specialty care. CONCLUSIONS: The most likely explanation for lower
mental health care costs in HMOs is a less intensive style of care for a
comparably sick population.
