Diehr P, Williams S J, Shortell S M, Richardson W C, Drucker W L
Med Care. 1979 Sep;17(9):937-52. doi: 10.1097/00005650-197909000-00005.
Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group included enrollees with at least one mental health service (MH-U) and the other included those with some somatic utilization but without mental health utilization (MH-NU). Results indicated that mental health users were different from nonusers based on sociodemographic, health status, and prior utilization measures. Further, the mental health utilizers consumed more somatic services than other enrollees, even controlling for background variables. The visit and admission rates for the MH-U group were 2.4 times that of the MH-NU group, and total inpatient and outpatient costs were three times as high. On all three comparisons, approximately 60 per cent of the difference was accounted for by mental health utilization and by differences in sociodemographic and health status characteristics. The remaining 40 per cent could not be explained, but there is a suggestion that the higher utilization occurred for conditions where medical care is discretionary.
心理健康服务包含在西雅图预付医疗保健项目的综合福利中，参保人无需自掏腰包。本研究旨在考察心理健康服务使用者与非使用者的特征，并探究由于心理健康服务的可获得性导致躯体健康服务使用量降低的可能性。研究了两组参保人：一组包括至少使用过一次心理健康服务的参保人（MH-U），另一组包括有一些躯体健康服务使用记录但未使用过心理健康服务的参保人（MH-NU）。结果表明，基于社会人口统计学、健康状况和既往使用情况指标，心理健康服务使用者与非使用者存在差异。此外，即使对背景变量进行控制，心理健康服务使用者比其他参保人消耗更多的躯体健康服务。MH-U组的就诊率和住院率是MH-NU组的2.4倍，住院和门诊总费用则是其3倍。在所有三项比较中，约60%的差异可归因于心理健康服务的使用以及社会人口统计学和健康状况特征的差异。其余40%无法解释，但有迹象表明，较高的使用率出现在医疗保健可自由选择的情况下。
