OUTCOMES FOR ADULT OUTPATIENTS WITH DEPRESSION UNDER PREPAID OR FEE-FOR-SERVICE FINANCING

Objective: To compare change over time in symptoms of depression and l imitations in role and physical functioning of patients receiving prep aid or fee-for-service care within and across clinician specialties. M ethod: Observational study of change in outcomes over 2 years for 617 depressed patients of psychiatrists, psychologists, other therapists, and general medical clinicians in three urban sites in the United Stat es. Results: Psychiatrists treated psychologically sicker patients tha n other clinicians in all payment types. Among psychiatrists' patients , those initially receiving prepaid care acquired new limitations in r ole/physical functioning over time, while those receiving fee-for-serv ice care did not. This finding was most striking in independent practi ce associations but varied by site and organization. Patients of psych iatrists were more likely to use antidepressant medication than were p atients of other clinicians, but among psychiatrists' patients, there was a sharp decline over time in the use of such medication in prepaid compared with fee-for-service care. Outcomes did not differ by paymen t type for depressed patients of other specialty groups, or overall. C onclusion: Depressed patients of psychiatrists merit policy interest o wing to their high levels of psychological sickness. For these patient s, functioning outcomes were poorer in some prepaid organizations. The nonexperimental evidence favors (but cannot prove) an explanation bas ed on care received, such as a reduction in medications, rather than o n preexisting sickness differences.