Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms

David E. Grembowski, Diane Martin, Donald L. Patrick, Paula Diehr, Wayne Katon, Barbara Williams, Ruth Engelberg, Louise Novak, Deborah Dickstein, Richard Deyo, Harold I. Goldberg

Research output: Contribution to journalArticle

64 Scopus citations

Abstract

OBJECTIVE: To determine whether managed care is associated with reduced access to mental health specialists and worse outcomes among primary care patients with depressive symptoms. DESIGN: Prospective cohort study. SETTING: Offices of 261 primary physicians in private practice in Seattle. PATIENTS: Patients (N = 17,187) were screened in waiting rooms, enrolling 1,336 adults with depressive symptoms. Patients (n = 942) completed follow-up surveys at 1, 3, and 6 months. MEASUREMENTS AND RESULTS: For each patient, the intensity of managed care was measured by the managedness of the patient's health plan, plan benefit indexes, presence or absence of a mental health carve-out, intensity of managed care in the patient's primary care office, physician financial incentives, and whether the physician read or used depression guidelines. Access measures were referral and actually seeing a mental health specialist. Outcomes were the Symptom Checklist for Depression, restricted activity days, and patient rating of care from primary physician. Approximately 23% of patients were referred to mental health specialists, and 38% saw a mental health specialist with or without referral. Managed care generally was not associated with a reduced likelihood of referral or seeing a mental health specialist. Patients in more-managed plans were less likely to be referred to a psychiatrist. Among low-income patients, a physician financial withhold for referral was associated with fewer mental health referrals. A physician productivity bonus was associated with greater access to mental health specialists. Depressive symptom and restricted activity day outcomes in more-managed health plans and offices were similar to or better than less-managed settings. Patients in more-managed offices had lower ratings of care from their primary physicians. CONCLUSIONS: The intensity of managed care was generally not associated with access to mental health specialists. The small number of managed care strategies associated with reduced access were offset by other strategies associated with increased access. Consequently, no adverse health outcomes were detected, but lower patient ratings of care provided by their primary physicians were found.

Original languageEnglish (US)
Pages (from-to)258-269
Number of pages12
JournalJournal of general internal medicine
Volume17
Issue number4
DOIs
StatePublished - May 2 2002

Keywords

  • Access
  • Behavioral medicine
  • Depression
  • Family medicine
  • Insurance
  • Internal medicine
  • Managed care programs
  • Mental health services
  • Outcome assessment
  • Physician referral
  • Primary care
  • Psychiatry
  • Psychology
  • Quality of care

ASJC Scopus subject areas

  • Internal Medicine

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    Grembowski, D. E., Martin, D., Patrick, D. L., Diehr, P., Katon, W., Williams, B., Engelberg, R., Novak, L., Dickstein, D., Deyo, R., & Goldberg, H. I. (2002). Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. Journal of general internal medicine, 17(4), 258-269. https://doi.org/10.1046/j.1525-1497.2002.10321.x