Diehr P, Price K, Williams S J, Martin D P
J Med Syst. 1985 Dec;9(5-6):389-400. doi: 10.1007/BF00992576.
A major topic in mental health (MH) research addresses the problem that patients who use mental health services have inappropriately high levels of somatic use, and examines whether provision of mental health services can decrease the inappropriate use (the so-called offset effect). However, the research showing higher somatic use by mental health patients has usually been unable to control for the patients' health status, or for their mental health status. In this paper we examine use of somatic health services by enrollees in three provider plans as a function of both mental health use and mental health need. In two of the provider plans (an HMO and a prepaid independent practice association), MH users used significantly more outpatient somatic services than non-MH patients, after control for age and sex, and after control for the number of chronic conditions they had. People with MH need, however, did not use significantly more MH services than those without MH need. In the third plan, a Blue Cross/Blue Shield type of plan, results were different; MH users did not have significantly higher somatic utilization after control for chronic conditions, and those with MH need did have significantly higher somatic utilization after control for age and sex, but not after control for the number of chronic conditions. These results suggest that the form of inappropriate use of outpatient somatic services, and the nature of an offset effect, may be specific to the type of insurance provided.
心理健康（MH）研究中的一个主要课题涉及到使用心理健康服务的患者存在躯体医疗服务使用水平过高的问题，并探讨提供心理健康服务是否能够减少这种不适当的使用（即所谓的抵消效应）。然而，那些表明心理健康患者有更高躯体医疗服务使用量的研究通常无法控制患者的健康状况或心理健康状况。在本文中，我们研究了参加三种医疗服务计划的人员对躯体健康服务的使用情况，将其作为心理健康服务使用和心理健康需求的一个函数。在其中两种医疗服务计划（一个健康维护组织和一个预付独立执业协会）中，在控制了年龄和性别以及他们所患慢性病数量之后，心理健康服务使用者比非心理健康患者使用门诊躯体医疗服务的量显著更多。然而，有心理健康需求的人使用心理健康服务的量并不比没有心理健康需求的人显著更多。在第三种计划，即蓝十字/蓝盾类型的计划中，结果有所不同；在控制了慢性病之后，心理健康服务使用者的躯体医疗服务利用率并没有显著更高，而有心理健康需求的人在控制了年龄和性别之后躯体医疗服务利用率确实显著更高，但在控制了慢性病数量之后则不然。这些结果表明，门诊躯体医疗服务不适当使用的形式以及抵消效应的性质可能因所提供保险的类型而异。
