Tsai S P, Reedy S M, Bernacki E J, Lee E S
Tenneco Inc., Health, Environmental Medicine & Safety, Houston, TX 77252.
Med Care. 1988 Apr;26(4):430-40. doi: 10.1097/00005650-198804000-00012.
This article presents the impact of a health insurance benefit redesign on utilization and costs for mental health care in a large corporation. The design change primarily limited coverage to 45 days of hospitalization and 20 outpatient visits. Group health insurance data before and after the benefit changes (effective January 1, 1984) were compared and analyzed. Per capita charges for mental health care between 1983 and 1985 decreased by 41%, from $89 to $53. Responses to the benefit modifications differed for inpatient and outpatient services. Inpatient costs and length of stay decreased dramatically, especially for dependents, while utilization rates remained about the same. Statistically significant increases occurred for outpatient care utilization and costs.
本文介绍了一项健康保险福利重新设计对一家大公司心理健康护理的利用率和成本的影响。设计变更主要将保险范围限制为45天住院和20次门诊就诊。对福利变更前后（1984年1月1日生效）的团体健康保险数据进行了比较和分析。1983年至1985年期间，心理健康护理的人均费用下降了41%，从89美元降至53美元。住院和门诊服务对福利变更的反应有所不同。住院成本和住院时间大幅下降，尤其是受抚养人的，而利用率基本保持不变。门诊护理的利用率和成本出现了统计学上的显著增长。
