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Am J Psychiatry 1996; 153:331-338
Copyright © 1996 by American Psychiatric Association
Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization
GE Simon, L Grothaus, ML Durham, M VonKorff and C Pabiniak
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101-1448, USA.
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.
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