Am J Psychiatry 1995; 152:1020-1025
Copyright © 1995 by American Psychiatric Association
Mental health and choice between managed care and indemnity health insurance
TV Perneger, AF Allaz, JF Etter and A Rougemont
Institute of Social and Preventive Medicine, University of Geneva, Switzerland.
OBJECTIVE: Populations enrolled in various health insurance plans may
differ in their health care needs. Whether mental health affects choice
among competing health plans is not clear. This study examined self-
selection by participants in a Swiss indemnity insurance plan that was
transformed into a managed care organization that controlled access to
specialists through gatekeeping and restricted coverage for psychiatric
treatments. METHOD: Information regarding past use of health services and
health status was provided by 421 persons who joined the new managed care
organization and 222 nonjoiners. The mental health and somatic health
characteristics of these two groups were compared. RESULTS: In the year
preceding the creation of the managed care organization, the nonjoiners had
made on average 2.3 more visits to psychiatrists than the joiners but 0.0
to 0.6 more visits to other physicians. The nonjoiners were more likely to
have used psychoactive medications but not other medications. The rates of
treatment for depression were similar in the two groups. The joiners
reported significantly lower mental health status, but not somatic health
status, than the nonjoiners. CONCLUSIONS: Both mental health status and
past use of mental health services strongly affected choice of health
insurance plan. The effects of somatic health and use of somatic health
services on selection were consistently weaker. People who join managed
care organizations may have substantial uncovered needs for psychiatric
care. Minimum mandatory benefits for mental health care may be an effective
countermeasure to unequitable self-selection.
