Patterns of mental health utilization over time in a fee-for-service population

This paper examines the multi-year patterns of ambulatory mental health care in a population of individuals continuously eligible to receive care in a fee-for-service setting. Among the 14,000 individuals eligible for all three years, 14 per cent used outpatient mental health services during at least one of the three years. Almost 70 per cent of the individuals with some use in 1980 used services during 1981 or 1982. The heaviest use of outpatient mental health and other physician services is among the persons using services in all three years. Our data are compared with three years of data reported by Kessler in an HMO (health maintenance organization) setting. The probability that a non-user becomes a user in roughly the same in the fee-for-service and HMO populations, but the probability of continuing use in the next year is much less in the HMO. This finding, that the "HMO effect" on mental health care is primarily on the visits per user rather than on the number of users, is consistent with other research.