Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization
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...
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| Veröffentlicht in: | The American journal of psychiatry 1996-03, Vol.153 (3), p.331-338 |
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| container_title | The American journal of psychiatry |
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| creator | SIMON, G. E GROTHAUS, L DURHAM, M. L VONKORFF, M PABINIAK, C |
| description | 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. |
| doi_str_mv | 10.1176/ajp.153.3.331 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_77973879</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>77973879</sourcerecordid><originalsourceid>FETCH-LOGICAL-a407t-6192f2f171612ee9838932bb1fe9ad410f0cc37f0376b5a249788602b42185593</originalsourceid><addsrcrecordid>eNp1kc-L1TAQx4Mo63P16FEIKh4W-swkbZMcl0XdhQUvCt7KtJu6ebRNTVLh-dc7z1cXWVbmkEy-n_mRGcZegtgC6Po97uYtVGpLpuAR29C9KrSU5jHbCCFkYSv17Sl7ltKOXKG0PGEnpgZhwG5YvBpn7DIPPf_pk8-8CzPuRzflxMPEw5JnzJ5cfnjDgd86HPItX7If_C-SCGr3JI6ti-mQBv8iI_opuwmnzvEQv-O08s_Zkx6H5F6s5yn7-vHDl4vL4vrzp6uL8-sCS6FzUYOVvexBQw3SOWuUsUq2LfTO4k0Johddp3RPP6rbCmVptTG1kG0pwVSVVafs3THvHMOPxaXcjD51bhhwcmFJjdZWK6MP4Ot74C4scaLeGilFWelalQS9-R8EFRgljflTszhSXQwpRdc3c_Qjxn0Dojmsq6F1UYBqyBQQ_2rNurSju7mj1_2Q_nbVMXU49JGm6dMdpoTQNB_Czo4YzrP_p7EHa_4GQ56qLg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1518328859</pqid></control><display><type>article</type><title>Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization</title><source>MEDLINE</source><source>Psychiatry Legacy Collection Online Journals 1844-1996</source><source>Periodicals Index Online</source><creator>SIMON, G. E ; GROTHAUS, L ; DURHAM, M. L ; VONKORFF, M ; PABINIAK, C</creator><creatorcontrib>SIMON, G. E ; GROTHAUS, L ; DURHAM, M. L ; VONKORFF, M ; PABINIAK, C</creatorcontrib><description>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.</description><identifier>ISSN: 0002-953X</identifier><identifier>EISSN: 1535-7228</identifier><identifier>DOI: 10.1176/ajp.153.3.331</identifier><identifier>PMID: 8610819</identifier><identifier>CODEN: AJPSAO</identifier><language>eng</language><publisher>Washington, DC: American Psychiatric Publishing</publisher><subject>Ambulatory Care - utilization ; Appointments and Schedules ; Attitude to Health ; Biological and medical sciences ; Community Mental Health Services - utilization ; Cost Sharing ; Deductibles and Coinsurance ; Fees and Charges ; Health Benefit Plans, Employee ; Health care expenditures ; Health Care Reform ; Health maintenance organizations ; Health Maintenance Organizations - economics ; HMOs ; Humans ; Insurance Claim Review ; Medical sciences ; Mental health ; Organization of mental health. Health systems ; Outpatient care facilities ; Probability ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Social psychiatry. Ethnopsychiatry ; United States ; Utilization Review</subject><ispartof>The American journal of psychiatry, 1996-03, Vol.153 (3), p.331-338</ispartof><rights>1996 INIST-CNRS</rights><rights>Copyright American Psychiatric Association Mar 1996</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a407t-6192f2f171612ee9838932bb1fe9ad410f0cc37f0376b5a249788602b42185593</citedby><cites>FETCH-LOGICAL-a407t-6192f2f171612ee9838932bb1fe9ad410f0cc37f0376b5a249788602b42185593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://psychiatryonline.org/doi/epdf/10.1176/ajp.153.3.331$$EPDF$$P50$$Gappi$$H</linktopdf><linktohtml>$$Uhttps://psychiatryonline.org/doi/full/10.1176/ajp.153.3.331$$EHTML$$P50$$Gappi$$H</linktohtml><link.rule.ids>314,776,780,2845,21609,27848,27903,27904,77537,77538</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3007716$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8610819$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SIMON, G. E</creatorcontrib><creatorcontrib>GROTHAUS, L</creatorcontrib><creatorcontrib>DURHAM, M. L</creatorcontrib><creatorcontrib>VONKORFF, M</creatorcontrib><creatorcontrib>PABINIAK, C</creatorcontrib><title>Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization</title><title>The American journal of psychiatry</title><addtitle>Am J Psychiatry</addtitle><description>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.</description><subject>Ambulatory Care - utilization</subject><subject>Appointments and Schedules</subject><subject>Attitude to Health</subject><subject>Biological and medical sciences</subject><subject>Community Mental Health Services - utilization</subject><subject>Cost Sharing</subject><subject>Deductibles and Coinsurance</subject><subject>Fees and Charges</subject><subject>Health Benefit Plans, Employee</subject><subject>Health care expenditures</subject><subject>Health Care Reform</subject><subject>Health maintenance organizations</subject><subject>Health Maintenance Organizations - economics</subject><subject>HMOs</subject><subject>Humans</subject><subject>Insurance Claim Review</subject><subject>Medical sciences</subject><subject>Mental health</subject><subject>Organization of mental health. Health systems</subject><subject>Outpatient care facilities</subject><subject>Probability</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Social psychiatry. Ethnopsychiatry</subject><subject>United States</subject><subject>Utilization Review</subject><issn>0002-953X</issn><issn>1535-7228</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>K30</sourceid><recordid>eNp1kc-L1TAQx4Mo63P16FEIKh4W-swkbZMcl0XdhQUvCt7KtJu6ebRNTVLh-dc7z1cXWVbmkEy-n_mRGcZegtgC6Po97uYtVGpLpuAR29C9KrSU5jHbCCFkYSv17Sl7ltKOXKG0PGEnpgZhwG5YvBpn7DIPPf_pk8-8CzPuRzflxMPEw5JnzJ5cfnjDgd86HPItX7If_C-SCGr3JI6ti-mQBv8iI_opuwmnzvEQv-O08s_Zkx6H5F6s5yn7-vHDl4vL4vrzp6uL8-sCS6FzUYOVvexBQw3SOWuUsUq2LfTO4k0Johddp3RPP6rbCmVptTG1kG0pwVSVVafs3THvHMOPxaXcjD51bhhwcmFJjdZWK6MP4Ot74C4scaLeGilFWelalQS9-R8EFRgljflTszhSXQwpRdc3c_Qjxn0Dojmsq6F1UYBqyBQQ_2rNurSju7mj1_2Q_nbVMXU49JGm6dMdpoTQNB_Czo4YzrP_p7EHa_4GQ56qLg</recordid><startdate>19960301</startdate><enddate>19960301</enddate><creator>SIMON, G. E</creator><creator>GROTHAUS, L</creator><creator>DURHAM, M. L</creator><creator>VONKORFF, M</creator><creator>PABINIAK, C</creator><general>American Psychiatric Publishing</general><general>American Psychiatric Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>HAWNG</scope><scope>HBMBR</scope><scope>IBDFT</scope><scope>K30</scope><scope>PAAUG</scope><scope>PAWHS</scope><scope>PAWZZ</scope><scope>PAXOH</scope><scope>PBHAV</scope><scope>PBQSW</scope><scope>PBYQZ</scope><scope>PCIWU</scope><scope>PCMID</scope><scope>PCZJX</scope><scope>PDGRG</scope><scope>PDWWI</scope><scope>PETMR</scope><scope>PFVGT</scope><scope>PGXDX</scope><scope>PIHIL</scope><scope>PISVA</scope><scope>PJCTQ</scope><scope>PJTMS</scope><scope>PLCHJ</scope><scope>PMHAD</scope><scope>PNQDJ</scope><scope>POUND</scope><scope>PPLAD</scope><scope>PQAPC</scope><scope>PQCAN</scope><scope>PQCMW</scope><scope>PQEME</scope><scope>PQHKH</scope><scope>PQMID</scope><scope>PQNCT</scope><scope>PQNET</scope><scope>PQSCT</scope><scope>PQSET</scope><scope>PSVJG</scope><scope>PVMQY</scope><scope>PZGFC</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>19960301</creationdate><title>Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization</title><author>SIMON, G. E ; GROTHAUS, L ; DURHAM, M. L ; VONKORFF, M ; PABINIAK, C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a407t-6192f2f171612ee9838932bb1fe9ad410f0cc37f0376b5a249788602b42185593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Ambulatory Care - utilization</topic><topic>Appointments and Schedules</topic><topic>Attitude to Health</topic><topic>Biological and medical sciences</topic><topic>Community Mental Health Services - utilization</topic><topic>Cost Sharing</topic><topic>Deductibles and Coinsurance</topic><topic>Fees and Charges</topic><topic>Health Benefit Plans, Employee</topic><topic>Health care expenditures</topic><topic>Health Care Reform</topic><topic>Health maintenance organizations</topic><topic>Health Maintenance Organizations - economics</topic><topic>HMOs</topic><topic>Humans</topic><topic>Insurance Claim Review</topic><topic>Medical sciences</topic><topic>Mental health</topic><topic>Organization of mental health. Health systems</topic><topic>Outpatient care facilities</topic><topic>Probability</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Social psychiatry. Ethnopsychiatry</topic><topic>United States</topic><topic>Utilization Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SIMON, G. E</creatorcontrib><creatorcontrib>GROTHAUS, L</creatorcontrib><creatorcontrib>DURHAM, M. L</creatorcontrib><creatorcontrib>VONKORFF, M</creatorcontrib><creatorcontrib>PABINIAK, C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Periodicals Index Online Segment 13</collection><collection>Periodicals Index Online Segment 14</collection><collection>Periodicals Index Online Segment 27</collection><collection>Periodicals Index Online</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - West</collection><collection>Primary Sources Access (Plan D) - International</collection><collection>Primary Sources Access & Build (Plan A) - MEA</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - Midwest</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - Northeast</collection><collection>Primary Sources Access (Plan D) - Southeast</collection><collection>Primary Sources Access (Plan D) - North Central</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - Southeast</collection><collection>Primary Sources Access (Plan D) - South Central</collection><collection>Primary Sources Access & Build (Plan A) - UK / I</collection><collection>Primary Sources Access (Plan D) - Canada</collection><collection>Primary Sources Access (Plan D) - EMEALA</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - North Central</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - South Central</collection><collection>Primary Sources Access & Build (Plan A) - International</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - International</collection><collection>Primary Sources Access (Plan D) - West</collection><collection>Periodicals Index Online Segments 1-50</collection><collection>Primary Sources Access (Plan D) - APAC</collection><collection>Primary Sources Access (Plan D) - Midwest</collection><collection>Primary Sources Access (Plan D) - MEA</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - Canada</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - UK / I</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - EMEALA</collection><collection>Primary Sources Access & Build (Plan A) - APAC</collection><collection>Primary Sources Access & Build (Plan A) - Canada</collection><collection>Primary Sources Access & Build (Plan A) - West</collection><collection>Primary Sources Access & Build (Plan A) - EMEALA</collection><collection>Primary Sources Access (Plan D) - Northeast</collection><collection>Primary Sources Access & Build (Plan A) - Midwest</collection><collection>Primary Sources Access & Build (Plan A) - North Central</collection><collection>Primary Sources Access & Build (Plan A) - Northeast</collection><collection>Primary Sources Access & Build (Plan A) - South Central</collection><collection>Primary Sources Access & Build (Plan A) - Southeast</collection><collection>Primary Sources Access (Plan D) - UK / I</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - APAC</collection><collection>Primary Sources Access—Foundation Edition (Plan E) - MEA</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SIMON, G. E</au><au>GROTHAUS, L</au><au>DURHAM, M. L</au><au>VONKORFF, M</au><au>PABINIAK, C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization</atitle><jtitle>The American journal of psychiatry</jtitle><addtitle>Am J Psychiatry</addtitle><date>1996-03-01</date><risdate>1996</risdate><volume>153</volume><issue>3</issue><spage>331</spage><epage>338</epage><pages>331-338</pages><issn>0002-953X</issn><eissn>1535-7228</eissn><coden>AJPSAO</coden><abstract>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.</abstract><cop>Washington, DC</cop><pub>American Psychiatric Publishing</pub><pmid>8610819</pmid><doi>10.1176/ajp.153.3.331</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-953X |
| ispartof | The American journal of psychiatry, 1996-03, Vol.153 (3), p.331-338 |
| issn | 0002-953X 1535-7228 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_77973879 |
| source | MEDLINE; Psychiatry Legacy Collection Online Journals 1844-1996; Periodicals Index Online |
| subjects | Ambulatory Care - utilization Appointments and Schedules Attitude to Health Biological and medical sciences Community Mental Health Services - utilization Cost Sharing Deductibles and Coinsurance Fees and Charges Health Benefit Plans, Employee Health care expenditures Health Care Reform Health maintenance organizations Health Maintenance Organizations - economics HMOs Humans Insurance Claim Review Medical sciences Mental health Organization of mental health. Health systems Outpatient care facilities Probability Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Social psychiatry. Ethnopsychiatry United States Utilization Review |
| title | Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization |
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