Jameson J, Shuman L J, Young W W
Med Care. 1978 May;16(5):383-99. doi: 10.1097/00005650-197805000-00003.
Although previous studies conducted in prepaid group practice settings have indicated that the cost of providing coverage for outpatient psychotherapy may be offset by lower utilization of medical/surgical services among those who receive the benefit, no such studies have been conducted in a fee-for-service setting, nor have actual before and after claims costs been compared. This study establishes a methodology for using routinely collected Blue Cross claims data to show how the acquisition and use of a given benefit affects total utilization patterns and the overall costs of providing third-party coverage. The use and cost of outpatient psychiatric coverage in one subscriber group is the particular application given to this methodology in this report. Blue Cross claims records of 136 subjects who utilized outpatient psychiatric benefits over a 48-month period were analyzed. Results indicate that overall medical/surgical utilization is reduced for that subgroup who used the outpatient psychotherapy benefit and that average costs dropped by $9.41, from $16.47 per patient per month before outpatient psychotherapy to $7.06 after contact, with costs being adjusted to reflect parity with the base year. Factors other than psychiatric intervention which may have brought about this cost reduction as well as policy implications of these results are discussed.
尽管之前在预付费团体医疗模式下进行的研究表明，为门诊心理治疗提供保险的成本可能会被受益人群中较低的医疗/外科服务利用率所抵消，但尚未在按服务收费模式下开展此类研究，也未对实际的理赔成本前后进行比较。本研究建立了一种利用常规收集的蓝十字理赔数据的方法，以展示获得和使用特定保险福利如何影响总使用模式以及提供第三方保险的总体成本。本报告将一个订阅者群体中门诊精神病保险的使用和成本作为该方法的具体应用实例。分析了136名在48个月期间使用门诊精神病福利的受试者的蓝十字理赔记录。结果表明，使用门诊心理治疗福利的亚组人群的总体医疗/外科服务利用率降低，平均成本下降了9.41美元，从门诊心理治疗前每位患者每月16.47美元降至接受治疗后每月7.06美元，成本经过调整以反映与基年的平价。讨论了除心理干预之外可能导致成本降低的其他因素以及这些结果的政策含义。
