Manning W G, Wells K B, Duan N, Newhouse J P, Ware J E
JAMA. 1986 Oct 10;256(14):1930-4.
The less generous insurance coverage for mental health care has generated some controversy. The major unresolved question is how the demand for outpatient mental health care responds to cost sharing. We used data from a randomized trial of fee-for-service health insurance for the nonelderly to address this question. The study enrolled 5809 persons. The results are based on 19 819 person-years of data. One hundred thirty-three percent more is spent on outpatient psychotherapy when care is free to patients than when they pay 95% of the fee, subject to an annual catastrophic limit. But, the absolute level of expenditure is low on all plans; $32 per person per year with free care. The response to psychotherapy services to cost sharing is insignificantly larger than that for outpatient general medical services. We found no evidence that more generous coverage for outpatient psychotherapy decreases total health expenditures.
心理健康护理保险覆盖范围较窄引发了一些争议。主要未解决的问题是门诊心理健康护理需求如何应对费用分担。我们使用了一项针对非老年人的按服务收费医疗保险随机试验的数据来解决这个问题。该研究招募了5809人。结果基于19819人年的数据。当患者免费接受护理时，门诊心理治疗的花费比他们支付95%的费用（有年度灾难性限额）时多133%。但是，所有计划的绝对支出水平都很低；免费护理时每人每年32美元。心理治疗服务对费用分担的反应并不比门诊普通医疗服务的反应显著更大。我们没有发现证据表明门诊心理治疗更慷慨的保险覆盖会降低总医疗支出。
