Fairbank A
Inquiry. 1989 Summer;26(2):170-81.
When insurance benefits for outpatient psychotherapy are expanded to cover alternative (less expensive) types of providers, lower reimbursements from beneficiaries' use of these providers may offset reimbursement increases attributable to any concomitant increase in demand for services. In this paper, outpatient claims data from Massachusetts Blue Shield for 1979-83 are used to estimate demand and substitution effects of a state mandate of direct reimbursement to social workers, starting April 1, 1982. Empirical results for the first year of the mandate showed that while the percentage of beneficiaries using the benefit did not change from 1981, eligible social workers in the state treated 10% of "new" users of the outpatient benefit and 2% of "continuing" users. While the substitution effect predominated, the particular characteristics of the Massachusetts case limit more general applicability of the results.
当门诊心理治疗的保险福利扩大到涵盖替代（成本较低）类型的服务提供者时，受益人群使用这些服务提供者导致的报销费用降低，可能会抵消因服务需求的任何相应增加而带来的报销增长。在本文中，利用1979 - 1983年马萨诸塞州蓝十字蓝盾公司的门诊理赔数据，来估计自1982年4月1日起该州一项直接向社会工作者报销的规定所产生的需求和替代效应。该规定实施第一年的实证结果表明，虽然使用该福利的受益人群比例与1981年相比没有变化，但该州符合条件的社会工作者接待了10%的门诊福利“新”使用者和2%的“持续”使用者。虽然替代效应占主导，但马萨诸塞州案例的特殊特征限制了这些结果更广泛的适用性。
