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Health care use by children receiving mental health services
1Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205.
Insights
Mental health treatment reduced medical care use in older children but not younger ones. The "offset" effect was limited to non-specialty care, not primary care visits.
Area of Science:
- Pediatric Health
- Mental Health Services Research
- Healthcare Utilization
Background:
- Assessing mental health treatment impact often involves measuring reduced medical care utilization, known as the "offset" effect.
- Existing research on the offset effect primarily focuses on adults, with limited and methodologically challenged studies in pediatric populations.
Purpose of the Study:
- To investigate the association between mental health treatment for psychosocial problems and subsequent medical care utilization in children.
- To determine if the "offset" effect is present in pediatric populations and identify factors influencing it.
Main Methods:
- A study examined health care utilization patterns following mental health treatment for children with psychosocial problems.
- Statistical analyses controlled for potentially confounding variables to assess the impact of mental health treatment.
Main Results:
- Mental health treatment was linked to decreased medical care use only in older children, specifically in non-mental health specialty care visits.
- No significant reduction in primary care visits was observed. Previous utilization patterns and co-occurring conditions were stronger predictors of primary care use than mental health treatment.
Conclusions:
- Mental health treatment does not significantly reduce overall medical care utilization in most children with psychosocial problems in pediatric settings.
- Future research should consider case mix variables to better understand the varied impact of mental health treatment on healthcare utilization in children.
Abstract:
Reduction in medical care utilization is one criteria for assessing the impact of mental health treatment for children with psychosocial problems. This reduction has been termed the "offset" effect. Almost all published research concerning offset after mental health treatment concerns adults, and the few studies in pediatric populations are limited by methodologic problems. A study of health care utilization after mental health treatment for children was conducted. Mental health treatment for psychosocial problems was significantly associated with decreased use of medical care only for older children, after potentially confounding variables were controlled for. Furthermore, this decreased use was found only for nonmental health specialty care visits. No reduction in primary care visits occurred. Other factors such as previous patterns of use and the presence of other morbidity were stronger predictors of subsequent primary health care use than was mental health treatment. Mental health treatment does not have a major impact on the high utilization of most children with psychosocial problems in pediatric settings. Because the reasons for this may be particular morbidity patterns in these children, future studies should include some measure of case mix as a potentially important variable in assessment of mental health treatment effects.