Wells K B, Manning W G, Benjamin B
Health Serv Res. 1986 Aug;21(3):453-74.
Does a prepaid group practice (PGP) deliver less outpatient mental health care than the fee-for-service (FFS) sector when they serve comparable populations with comparable benefits? To examine this issue, we used data from the Rand Health Insurance Study, which randomized families into a prepaid group practice or FFS insurance plans. Participants in a FFS plan with no cost sharing (i.e., free care) are equally likely to visit a mental health specialist in a year, but incur 2.8 times the costs of prepaid participants (p less than .05). This difference is due to fewer visits per user, substitution of psychiatric social workers for psychiatrists and psychologists, and reliance on group rather than individual therapies in the prepaid plan. Because of the experimental design, these differences are due to institutional and incentive differences rather than adverse selection. We found no evidence of appreciable or significant adverse selection into or out of the prepaid group practice. A full evaluation of the desirability of prepaid or fee-for-service care requires data on health outcomes, which are not presented here.
当预付费团体医疗模式（PGP）和按服务收费（FFS）模式为具有相似福利的相似人群提供服务时，前者提供的门诊心理健康护理服务是否比后者少？为了研究这个问题，我们使用了兰德健康保险研究的数据，该研究将家庭随机分为预付费团体医疗模式或按服务收费保险计划。参加无费用分担（即免费医疗）的按服务收费计划的参与者在一年内去看心理健康专家的可能性相同，但费用是预付费参与者的2.8倍（p小于0.05）。这种差异是由于每个用户就诊次数较少、用精神科社会工作者替代精神科医生和心理学家，以及在预付费计划中依赖团体治疗而非个体治疗。由于实验设计，这些差异是由于制度和激励差异而非逆向选择。我们没有发现有明显或显著的逆向选择进入或退出预付费团体医疗模式的证据。对预付费或按服务收费医疗的可取性进行全面评估需要健康结果数据，本文未提供这些数据。
