MENTAL-HEALTH AND CHOICE BETWEEN MANAGED CARE AND INDEMNITY HEALTH-INSURANCE

Objective: Populations enrolled in various health insurance plans may differ in their health care needs. Whether mental health affects choic e among competing health plans is not clear, This study examined self- selection by participants in a Swiss indemnity insurance plan that was transformed into a managed care organization that controlled access t o specialists through gatekeeping and restricted coverage for psychiat ric treatments. Method: Information regarding past use of health servi ces and health status was provided by 421 persons who joined the new m anaged care organization and 222 nonjoiners. The mental health and som atic health characteristics of these two groups were compared. Results : In the year preceding the creation of the managed care organization, the nonjoiners had made on average 2.3 more visits to psychiatrists t han the joiners but 0.0 to 0.6 more visits to other physicians. The no njoiners were more likely to have used psychoactive medications but no t other medications. The rates of treatment for depression were simila r in the two groups. The joiners reported significantly lower mental h ealth status, but not somatic health status, than the nonjoiners. Conc lusions: Both mental health status and past use of mental health servi ces strongly affected choice of health insurance plan. The effects of somatic health and use of somatic health sen,ices on selection were co nsistently weaker. People who loin managed care organizations may have substantial uncovered needs for psychiatric care. Minimum mandatory b enefits for mental health care may be an effective countermeasure to u nequitable self-selection.