Wells K B, Manning W, Benjamin B
Med Care. 1986 Oct;24(10):949-60. doi: 10.1097/00005650-198610000-00008.
The authors compared the effects of age, sex, socioeconomic status, and mental and physical health status on the use of outpatient mental health services in one well-established health maintenance organization (HMO) and in fee-for-service plans. In the Seattle site of the Rand Health Insurance Study (HIS), families were randomly assigned to HMO or fee-for-service coverage. Adults incur much greater expense for outpatient mental health services than children in both an HMO and a fee-for-service plan with identical coverage (i.e., free care). However, the difference in use between adults and children is significantly greater for the fee-for-service plan than the HMO (P less than 0.01). Similarly, education has significantly greater effects on use for the fee-for-service than the HMO plan. Increased income has a significant negative effect on use in both the HMO and fee-for-service plans. Mental and physical health status have similar large effects on use in both fee-for-service and HMO plans.
作者比较了年龄、性别、社会经济地位以及精神和身体健康状况对一家成熟的健康维护组织（HMO）和按服务收费计划中门诊心理健康服务使用情况的影响。在兰德健康保险研究（HIS）的西雅图站点，家庭被随机分配到HMO或按服务收费保险。在保险范围相同（即免费护理）的HMO和按服务收费计划中，成年人的门诊心理健康服务费用比儿童高得多。然而，按服务收费计划中成人和儿童在使用上的差异比HMO显著更大（P小于0.01）。同样，教育对按服务收费计划使用情况的影响比对HMO计划显著更大。收入增加对HMO和按服务收费计划的使用都有显著的负面影响。精神和身体健康状况对按服务收费计划和HMO计划的使用都有类似的重大影响。
