Savoca E
Smith College, Northampton, MA, USA.
Adv Health Econ Health Serv Res. 1993;14:123-37.
This study provides evidence on the role of the public sector in the allocation of ambulatory specialty mental health services across income groups in the adult population. Results suggest that in the early to mid-1980s, the tax and transfer system effectively lowered the price of services to the poor and the rich, thus causing the highest use by persons at the extreme ends of the income distribution. High utilization at the low end of the income scale can be largely attributed to publicly provided insurance. A comparison of demand prior to the Medicaid cuts brought on by the Omnibus Budget and Reconciliation Act (OBRA) of 1981 with post-OBRA estimates reveals the extreme sensitivity of demand to changes in coverage. Among upper income groups the results imply that the implicit price of specialty mental health care falls as income rises. This finding is consistent with the hypothesis that the government's exclusion of health benefits and expenditures from taxation effectively lowers the price of medical services to individuals in high marginal income tax brackets. It also suggests that recent proposals to limit the tax exclusion of employer-paid premiums may lead to a more equitable distribution of resources in the specialty mental health sector.
本研究提供了关于公共部门在成年人口各收入群体间门诊专科心理健康服务分配中所起作用的证据。结果表明，在20世纪80年代初至中期，税收和转移支付系统有效地降低了穷人和富人获得服务的价格，从而导致收入分配两端的人群使用率最高。收入水平低端的高使用率在很大程度上可归因于公共提供的保险。将1981年《综合预算协调法案》（OBRA）带来的医疗补助削减之前的需求与OBRA之后的估计进行比较，揭示了需求对保险覆盖范围变化的极端敏感性。在高收入群体中，结果表明专科心理健康护理的隐性价格随收入增加而下降。这一发现与以下假设一致：政府将健康福利和支出排除在税收之外，有效地降低了高边际所得税税率人群获得医疗服务的价格。这也表明，最近限制雇主支付保费税收抵免的提议可能会导致专科心理健康领域的资源分配更加公平。
