title: The effect of insurance benefit changes on use of child and adolescent outpatient mental health services.
abstract: 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.
authors.affiliation: School of Social Work, New York University, New York.
authors.forename: D K
authors.initials: DK
authors.lastname: Padgett
authors.forename: C
authors.initials: C
authors.lastname: Patrick
authors.forename: B J
authors.initials: BJ
authors.lastname: Burns
authors.forename: H J
authors.initials: HJ
authors.lastname: Schlesinger
authors.forename: J
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D004219:District of Columbia; D005006:Ethnicity; D005260:Female; D006801:Humans; D007342:Insurance Benefits; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011336:Probability; D014481:United States