Wells K B, Manning W G, Duan N, Newhouse J P, Ware J E
Health Serv Res. 1987 Apr;22(1):1-17.
Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.
许多患有情绪障碍的患者从普通内科医生那里接受心理健康护理。在本文中，我们研究了心理健康专家提供的心理健康护理与普通内科医生提供的心理健康护理在成本和方式上的差异，以及患者选择心理健康护理提供者对保险的敏感度。我们使用了一项成本分摊随机试验——兰德健康保险实验的数据。即使所有门诊心理健康护理都是免费的（每年最多52次就诊），仍有一半的门诊心理健康服务使用者只去看普通内科医生。这一半人仅占门诊心理健康护理支出的5%，因为普通内科医生提供的治疗强度远低于心理健康专家提供的治疗强度。在入组时，从任何一个提供者组接受心理健康护理的人的心理健康状况相似。尽管护理成本存在巨大差异，但提供者的选择（心理健康专家与普通内科医生）对保险的慷慨程度并不敏感。
