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Related Experiment Videos

Depressive symptoms and plan switching under managed care.

B Druss1, M Schlesinger, T Thomas

  • 1Department of Psychiatry, Yale University, West Haven, CT 06516, USA.

The American Journal of Psychiatry
|May 18, 1999
PubMed
Summary

Individuals with high depressive symptoms are less likely to switch health plans when dissatisfied. This impacts the effectiveness of managed care competition for this population.

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Area of Science:

  • Health Services Research
  • Mental Health Services
  • Health Economics

Background:

  • Managed care systems often rely on plan switching as a mechanism for quality improvement.
  • Enrollee dissatisfaction is a key driver for plan switching in competitive healthcare markets.

Purpose of the Study:

  • To investigate whether depressive symptoms influence the likelihood of health plan switching among dissatisfied enrollees.
  • To test the hypothesis that the plan switching mechanism is less effective for individuals with high depressive symptom levels.

Main Methods:

  • Utilized data from the Employee Health Care Value Survey (n=20,283).
  • Employed the Medical Outcomes Study 36-Item Short-Form Health Survey to identify individuals with high depressive and physical symptoms.
  • Conducted multivariate analyses to examine the relationship between symptoms, dissatisfaction, and plan switching, controlling for confounders.

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Main Results:

  • Both depressive and physical symptoms correlated with dissatisfaction with healthcare.
  • Depressive symptoms, unlike physical symptoms, significantly reduced the likelihood of plan switching among dissatisfied individuals.
  • This effect was particularly evident for dissatisfaction with administrative aspects of care, such as utilization review and gatekeeping.

Conclusions:

  • Individuals experiencing high levels of depressive symptoms may be less able or willing to switch health plans due to dissatisfaction.
  • These individuals may tolerate greater dissatisfaction with administrative healthcare processes without disenrolling.
  • The effectiveness of competitive healthcare systems, reliant on plan switching, may be diminished for those with depressive disorders.