Wells K B, Manning W G, Valdez R B
RAND Corporation, Santa Monica, Calif 90406.
Arch Gen Psychiatry. 1989 Apr;46(4):315-20. doi: 10.1001/archpsyc.1989.01810040021004.
Reductions in the generosity of fee-for-service insurance lower the use of general medical and mental health services, but do they lead to lower mental health status for the covered population? We addressed this question using data from the RAND Corporation Health Insurance Experiment. Families in six sites in the United States were randomly assigned to one of 14 insurance plans for three- or five-year periods. On average, there were no significant adverse effects of cost-sharing plans, relative to a free-care plan, on either psychological well-being or psychological distress, when the cost-sharing plans included full catastrophic coverage. Those with high mental health status but low income at baseline had significantly more favorable mental health outcomes on the cost-sharing plans than on the free-care plan. We cannot definitively comment on the effects of insurance generosity for the sick poor. Our findings apply in the context of mandated comprehensive mental and general health coverage for a general nonelderly, nondisabled household population.
按服务收费保险的慷慨程度降低会减少一般医疗和心理健康服务的使用，但这会导致参保人群的心理健康状况下降吗？我们利用兰德公司医疗保险实验的数据来解决这个问题。美国六个地点的家庭被随机分配到14种保险计划中的一种，为期三年或五年。平均而言，当费用分摊计划包括全额灾难性保险时，相对于免费医疗计划，费用分摊计划对心理健康或心理困扰均无显著不利影响。基线时心理健康状况良好但收入较低的人群，在费用分摊计划下的心理健康结果比在免费医疗计划下更有利。我们无法对保险慷慨程度对患病贫困人口的影响做出明确评论。我们的研究结果适用于为一般非老年、非残疾家庭人口强制提供全面心理健康和一般健康保险的情况。
