IMPACT OF VISIT COPAYMENTS ON OUTPATIENT MENTAL-HEALTH UTILIZATION BYMEMBERS OF A HEALTH MAINTENANCE ORGANIZATION

Objective: The authors examined the impact of increasing cost sharing on use of outpatient mental health services. Method: A quasi-experimen tal design was used to study outpatient utilization by members of a he alth maintenance organization (HMO) who were subject to increasing cop ayments for mental health visits (state government employees and depen dents). Their outpatient mental health utilization was compared with t hat of similar HMO members who were not subject to cost shaving (feder al government employees and dependents). Analyses compared both likeli hood of any service use and number of visits per year among service us ers. Results: Institution of $20/visit copayments was associated with a 16% decrease in likelihood of service use but no change in visit rat e among service users. A subsequent copayment increase to $30/visit re sulted in no significant change in likelihood of use but was associate d with a 9% decrease in visits per year among those using services. Th e impact of the first copayment change on likelihood of using services did not vary according to level of clinical need (as measured by prio r service use and psychotropic drug use). Conclusions: In this staff-m odel HMO, modest visit copayments significantly reduced initial access to mental health treatment and had a smaller effect on treatment inte nsity. Copayments restricted access regardless of clinical need. Desig ners of mental health benefits must consider the impact of copayments on those with the greatest need for treatment.