Cost-sharing and the use of general medical physicians for outpatient mental health care

UMMS Affiliation

Department of Quantitative Health Sciences

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Document Type



Adult; Ambulatory Care; Child; *Deductibles and Coinsurance; Family Practice; Female; *Health Expenditures; Humans; Mental Health Services; Mental Status Schedule; United States


Biostatistics | Epidemiology | Health Services Research


Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.


Health Serv Res. 1987 Apr;22(1):1-17. Link to article on publisher's site

Journal/Book/Conference Title

Health services research

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Related Resources

Link to Article in PubMed