Ambulatory mental health treatment under universal coverage: policy insights from Israel.
Untested assumptions concerning ambulatory treatment have shaped mental health policies for decades. Three opinions prevail: (1) all use is alike; (2) any use leads to high use; and (3) all high use is discretionary and therefore excessive. These assumptions were tested, using data from a nationwide survey of ambulatory utilizers in Israel, a country that has universal coverage. The findings, based on detailed clinical and treatment records, challenge all three assumptions. Moreover, they document a diversity of clinical needs while also verifying substantial variations in the type, frequency, and duration of treatment provided to meet those needs. In brief, Israeli data do not confirm continuing concerns by policy makers about uncontrollable use of services with expanded mental health coverage. Special policy limitations on mental health treatment should be reconsidered in light of empirical evidence from a system without the restrictions that exist in the United States.
Feinson
M C
MC
Department of Information and Evaluation, Mental Health Services, Ministry of Health, Jerusalem, Israel.
Lerner
Y
Y
Levinson
D
D
Popper
M
M
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D007557:Israel; D008605:Mental Health Services / Q000706:statistics & numerical data*; D014481:United States; D019472:Universal Health Insurance