SWITCHES BETWEEN PREPAID AND FEE-FOR-SERVICE HEALTH SYSTEMS AMONG DEPRESSED OUTPATIENTS - RESULTS FROM THE MEDICAL OUTCOMES STUDY

We analyzed switches between prepaid and fee-for-service health care p lans among depressed outpatients in the longitudinal part of the Medic al Outcomes Study. Patients of mental health specialists in fee-for-se rvice plans had the lowest adjusted rate of plan switching (8.1%), com pared to fee-for-service general medical patients (13.5%) and prepaid patients of both types of providers (10.1% to 11.7%). Although there w ere no substantial differences in initial sickness by payment system a mong enrolled patients, differing switching rates by provider specialt y and payment system indicated biased selection over time. In addition , we found that married, nonwhite, and wealthier individuals were sign ificantly more likely to leave fee-for-service than prepaid care plans . We analyzed whether system switching had an effect on patient satisf action and outcomes. None of the results were highly significant, but the power of the data to analyze this issue was limited. Nevertheless, it appears that patients switching from prepaid to fee-for-service ma y be at risk for poorer functioning outcomes, although there was no si milar effect on mental health status.