Wells K B, Manning W G, Duan N, Newhouse J P, Ware J E
Med Care. 1986 Jan;24(1):75-85. doi: 10.1097/00005650-198601000-00008.
What are the effects of sociodemographic factors on the use of outpatient mental health services when different demographic groups have identical health insurance coverage? The authors answer this question using data from the Rand Health Insurance Experiment. Health insurance was randomly assigned to families representative of the nonaged, noninstitutionalized civilian population in six U.S. sites. Income has no significant total effect on use when all income groups have the same coverage. When the effects of variables correlated with socioeconomic status are removed, users with higher socioeconomic status are significantly more likely to choose a mental health specialist rather than only general medical providers for their mental health care (P less than 0.05); among those who visit mental health specialists, those with higher socioeconomic status incur significantly greater expenses (P less than 0.10). Women use significantly more mental health services than men (P less than 0.05), who in turn use significantly more mental health services than children (P less than 0.05), even after controlling for demographic factors, health status, and insurance coverage. Similarly, there are large differences (roughly sixfold) by site in outpatient mental health expenses even when all sites have identical coverage.
当不同人口群体拥有相同的医疗保险覆盖范围时，社会人口因素对门诊心理健康服务的使用有何影响？作者利用兰德健康保险实验的数据回答了这个问题。医疗保险被随机分配给美国六个地区具有非老年、非机构化平民人口代表性的家庭。当所有收入群体具有相同的保险覆盖范围时，收入对使用情况没有显著的总体影响。当去除与社会经济地位相关的变量的影响后，社会经济地位较高的使用者在寻求心理健康护理时，显著更有可能选择心理健康专科医生而非仅选择普通医疗服务提供者（P<0.05）；在就诊于心理健康专科医生的人群中，社会经济地位较高者的费用显著更高（P<0.10）。即使在控制了人口因素、健康状况和保险覆盖范围之后，女性使用的心理健康服务仍显著多于男性（P<0.05），而男性使用的心理健康服务又显著多于儿童（P<0.05）。同样，即使所有地区的保险覆盖范围相同，门诊心理健康费用在不同地区之间仍存在很大差异（约六倍）。
