Hustead E C, Sharfstein S S
Am J Psychiatry. 1978 Mar;135(3):315-9. doi: 10.1176/ajp.135.3.315.
The authors examine the utilization of mental illness benefits under the Blue Cross/Blue Shield and Aetna plans for federal employees; the latter plan sharply cut back its mental illness benefits in 1975. In 1973 mental illness benefits represented 7.4% of all payments under the Blues plan and 12% under the Aetna plan. The benefit for mental illness treatment under the Blues averaged $12.52 per person covered and was 7.3% of the total benefits for all conditions. Younger enrollees and their spouses tended to receive mental illness benefits primarily for outpatient treatment and children and older adults for hospitalization. These data raise key questions for claims review and peer review activities.
作者们研究了联邦雇员在蓝十字/蓝盾计划和安泰计划下对精神疾病福利的使用情况；后者在1975年大幅削减了其精神疾病福利。1973年，精神疾病福利在蓝十字计划下的所有赔付中占7.4%，在安泰计划下占12%。蓝十字计划下精神疾病治疗的福利平均每人12.52美元，占所有疾病总福利的7.3%。年轻参保者及其配偶主要因门诊治疗获得精神疾病福利，而儿童和老年人则因住院获得福利。这些数据为理赔审查和同行评审活动提出了关键问题。
