Padgett D K, Patrick C, Burns B J, Schlesinger H J, Cohen J
School of Social Work, New York University, New York.
Med Care. 1993 Feb;31(2):96-110. doi: 10.1097/00005650-199302000-00002.
Use of outpatient mental health services by dependent children younger than 18 years of age enrolled in the Blue Cross and Blue Shield Federal Employees Plan (FEP) is examined in 1978 and 1983 focusing on a cut in benefits and a shift from high- to low-option plan enrollment between those years. While use rates increased from 2.13% to 2.76% by 1983, the average number of visits decreased from 18.9 to 12.8. High-option plan use exceeded low-option plan use in both years--2.26% versus 0.81% in 1978 and 3.58% versus 1.93% in 1983. In addition to benefit plan, ethnicity, parent's education, type of provider, and type of treatment setting also significantly predicted amount of use. Despite the strong evidence of the effects of benefit coverage, it is likely that need exceeded use even in this insured population of children and adolescents. Implications of the findings are discussed in the context of recent dramatic changes in mental service delivery including privatization, managed care initiatives to cut costs, and growing pressures for national health insurance.
本研究对1978年和1983年参加蓝十字蓝盾联邦雇员计划（FEP）的18岁以下受抚养儿童的门诊心理健康服务使用情况进行了调查，重点关注这几年间的福利削减以及从高选项计划参保向低选项计划参保的转变。到1983年，使用率从2.13%上升至2.76%，但平均就诊次数从18.9次降至12.8次。这两年中，高选项计划的使用均超过低选项计划——1978年为2.26%对0.81%，1983年为3.58%对1.93%。除了福利计划外，种族、父母教育程度、提供者类型和治疗环境类型也显著预测了使用量。尽管有充分证据表明福利覆盖会产生影响，但即使在这个有保险的儿童和青少年群体中，需求可能仍超过了使用。研究结果的意义将在近期精神服务提供方面的巨大变化背景下进行讨论，这些变化包括私有化、控制成本的管理式医疗举措以及国家医疗保险面临的日益增长的压力。
