Considerations in predicting mental health care use: Implications for managed care plans

Abstract

Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.

Use of health services for major depressive and anxiety disorders in Finland

“…The likelihood of depression and anxiety disorders being treated has been linked to a variety of factors, including being female, older, separated, divorced or widowed, unemployed, and better educated [Olfson and Klerman, 1992;Crow et al, 1994;Lin and Parikh, 1999]. In our subjects, help-seeking for mental problems was constant up to the age of 60 years, after which a distinct decrease was observed, consistent with earlier findings [Roness et al, 2005].…”

“…Previous studies [Leaf et al, 1988;Bassett et al, 1998;Lefebvre et al, 1998;Ten Have et al, 2002] have suggested that severity of the psychiatric symptoms, psychiatric comorbidity, available resources, and different health behavior patterns influence seeking treatment. Also, different sociodemographic factors may have an influence on help-seeking [Olfson and Klerman, 1992;Crow et al, 1994;Lin and Parikh, 1999]. Although several recommendations and consensus statements have been produced in order to define the role of general and specialist psychiatric health care services [Alonso et al, 2004], little is known about the factors affecting the actual flow of patients in the health care system.…”

Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study

“…This finding is consistent with findings from numerous previous studies. 25,[30][31][32] Among the total population, 6% visited ambulatory mental health care services, of whom 2.4% (3.1% of 76.5% [ Table 1]) did not fulfill the DSM-III-R criteria. One might conclude that the mental health care sector is indeed dealing with overmet needs (i.e., too many-40%-mild cases that could better be treated in primary care).…”

The primary care provider's view

“…As we begin to explore how best to deploy mental health resources against the mental health problems of a population, or a panel, of patients, i t i s wise to first take stock of the resources currently being expended in this effort and their distribution. For example, an average of 5 percent of a two thousand-patient panel will complete mental health referrals, and these one hundred patients receive an average of five one-hour mental health visits (Crow, Smith, McNamee, and Piland, 1994): one-fifth with a psychiatrist, onefifth with a case manager, and three-fifths with a psychologist, psychiatric nurse practitioner, or social worker therapist. This is one hundred hours per year of a psychiatrist, one hundred hours of a case manager, and three hundred hours of therapist availability for this panel of patients.…”