Article

The Effect of Insurance Benefit Changes and Use of Child Adolescent Outpatient Mental Health Services

Duke University, Durham, North Carolina, United States
Medical Care (Impact Factor: 2.94). 03/1993; 31(2):96-110. DOI: 10.1097/00005650-199302000-00002
Source: PubMed

ABSTRACT Use of outpatient mental health services by dependent children younger than 18 years of age enrolled in the Blue Cross and Blue Shield Federal Employees Plan (FEP) is examined in 1978 and 1983 focusing on a cut in benefits and a shift from high- to low-option plan enrollment between those years. While use rates increased from 2.13% to 2.76% by 1983, the average number of visits decreased from 18.9 to 12.8. High-option plan use exceeded low-option plan use in both years--2.26% versus 0.81% in 1978 and 3.58% versus 1.93% in 1983. In addition to benefit plan, ethnicity, parent's education, type of provider, and type of treatment setting also significantly predicted amount of use. Despite the strong evidence of the effects of benefit coverage, it is likely that need exceeded use even in this insured population of children and adolescents. Implications of the findings are discussed in the context of recent dramatic changes in mental service delivery including privatization, managed care initiatives to cut costs, and growing pressures for national health insurance.

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    • "It is known that economics drives a significant portion of variability in seeking and receiving treatment for both White and ethnic minority members of the population. Insurance coverage significantly influences utilization of mental health services for adults and children (Padgett et al. 1993; Wu et al. 2001). Socioeconomic variables and family structure have a strong influence on service use for ethnic groups (Pumariega et al. 1998). "
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    • "Commonly examined child characteristics include demographic and clinical status variables. In terms of child characteristics, findings regularly reveal that male children are more likely to be referred and use mental health services in comparison to female children [31] [32], and they tend to use more services when involved in treatment [33] [34]. As children get older, the disparity between rates of service use by gender tends to decrease [31] [35]. "
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    • "service use and costs among children (Farmer, Stangl, Bums, et al. 1999; Gresenz, Liu, and Sturm 1998; Padgett, Patrick, Bums, et al. 1993). The goal of managed care is to reduce total health costs by substituting less costdy outpatient care for expensive inpatient services (Goldman, McCulloch, and Sturm 1998), using such mechanisms as utilization review, exclusive contracts with selected providers, and risk sharing. "
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