Golberstein Ezra, Eisenberg Daniel, Downs Marilyn F
Division of Health Policy and Management and Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA.
Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
Health Econ. 2016 Jan;25(1):40-55. doi: 10.1002/hec.3120. Epub 2014 Nov 17.
Spillover effects in health service use may represent an important externality of individual treatment decisions and are important for understanding the consequences of interventions to improve access to health care. This study is the first to our knowledge to examine causal spillover effects for mental health service use. We exploit the natural experiment of first-year student housing assignments at two universities using survey data that we collected. When the peer group is defined at the roommate level, we do not find any spillover effects on service use. When the peer group is defined at the hall level, we find positive spillover effects--peers' service use increases one's own service use--and this effect is driven by individuals with prior experience with mental health services. We also find some evidence that the mechanism behind this effect is improved beliefs about treatment effectiveness.
医疗服务使用中的溢出效应可能代表了个体治疗决策的一个重要外部性,对于理解改善医疗服务可及性干预措施的后果具有重要意义。据我们所知,本研究是首个检验心理健康服务使用因果溢出效应的研究。我们利用两所大学一年级学生宿舍分配这一自然实验,使用我们收集的调查数据。当同龄群体在室友层面进行定义时,我们未发现对服务使用有任何溢出效应。当同龄群体在宿舍楼层面进行定义时,我们发现了正向溢出效应——同伴的服务使用会增加自己的服务使用——且这一效应由有心理健康服务既往经历的个体驱动。我们还发现一些证据表明,这一效应背后的机制是对治疗效果的信念得到改善。