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This report presents interim results on the demand for ambulatory mental health services, using data from the RAND Health Insurance Study. Major empirical findings of this study that bear on the cost sharing policy questions include: Reducing the level of cost sharing in the HIS plans increases the demand for mental health services; small deductibles have a statistically insignificant effect on expenses as compared with free care; with the exception of the $150 per person annual deductible plan, expenses for ambulatory mental health services exhibit roughly the same percentage response to changes in insurance as do ambulatory medical expenses; the level of expenditures on ambulatory mental health care is low; and those with different incomes and mental health statuses respond similarly to changes in insurance coverage. Also included are findings related to the mix of providers for mental health services.

Mental health services --- Ambulatory medical care --- Mental health insurance --- Deductibles and coinsurance. --- Ambulatory care --- Utilization --- Economics --- Mental Health Services --- Deductibles and Coinsurance. --- Ambulatory Care

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Preferred provider organizations (PPOs), which offer some of the advantages of both fee-for-service and managed care, are becoming an important market force. This report provides empirical estimates of the effects of offering a PPO option within indemnity plans on use of outpatient mental health services. The data are from a study that examined a sample of employees who had enrolled in indemnity plans before and after a PPO option was offered by three employers in two U.S. sites. The authors found little evidence for either adverse or favorable selection of indemnity enrollees on the basis of their mental health status into use of the PPO option, either for general medical care or for mental health care. After controlling for other factors, the authors found no significant association between mental health status and intent to use PPO providers for general medical care. The pattern of results suggests that established provider relationships, rather than level of mental health status per se, determine selection of provider among users of outpatient mental health care. By the second year following PPO implementation, after controlling for sociodemographic factors and previous use of mental health services, there was no difference in probability of use of outpatient mental health services between employees who expected to use PPO providers and those who did not. But costs per user of mental health services were lower for individuals who relied primarily on PPO rather than non-PPO providers for their mental health care. Thus, despite lower cost sharing for services received from PPO providers, the PPO option appeared to lower outpatient mental health care costs with no more than a transient reduction in access to such care.

Mental health services --- Ambulatory medical care --- Preferred provider organizations (Medical care) --- Mental health insurance. --- Ambulatory Care --- Health Benefit Plans, Employee --- Preferred Provider Organizations --- Utilization --- utilization