A previous study of low-income enrollees in a closedpanel health maintenance organization (HMO) and a Blue Cross/ Blue Shield (BC/BS) plan showed that the effect on the use of health services of the age, sex, health status, previous health care use, race, and family size of the enrollees was different in the two plans. We have replicated this study using the same two provider plans but studying a different group of white collar, middle class enrollees. A third plan, an experimental independent practice association (IPA), was also available for analysis. Utilization was defined as use
IntroductionMany studies have found patient characteristics to be correlated with the use of health services. ' However, we are aware of only one study of whether the effects of these correlates on ambulatory use is the same in different provider plans.2'3 That study compared a closed-panel health maintenance organization (HMO) to a comprehensive Blue Cross/Blue Shield (BC/BS) plan. The age, sex, health status, previous cost of services, and family size of enrollees had less effect on the number of visits in the HMO than in the BC/BS plan. However, the effect of race was stronger in the HMO.Since these findings might have been unique to the time period or to the low income of the enrollees studied, we have replicated this analysis using new ambulatory care data on largely middle class, white collar enrollees in the two original plans and a third plan, an independent practice association (IPA).
A major topic in mental health (MH) research addresses the problem that patients who use mental health services have inappropriately high levels of somatic use, and examines whether provision of mental health services can decrease the inappropriate use (the so-called offset effect). However, the research showing higher somatic use by mental health patients has usually been unable to control for the patients' health status, or for their mental health status. In this paper we examine use of somatic health services by enrollees in three provider plans as a function of both mental health use and mental health need. In two of the provider plans (an HMO and a prepaid independent practice association), MH users used significantly more outpatient somatic services than non-MH patients, after control for age and sex, and after control for the number of chronic conditions they had. People with MH need, however, did not use significantly more MH services than those without MH need. In the third plan, a Blue Cross/Blue Shield type of plan, results were different; MH users did not have significantly higher somatic utilization after control for chronic conditions, and those with MH need did have significantly higher somatic utilization after control for age and sex, but not after control for the number of chronic conditions. These results suggest that the form of inappropriate use of outpatient somatic services, and the nature of an offset effect, may be specific to the type of insurance provided.
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