MENIAL HEALTH-CARE USE, MORBIDITY, AND SOCIOECONOMIC-STATUS IN THE UNITED-STATES AND ONTARIO

This study focuses on mental health problems and compares the associat ion of demographic and socioeconomic factors to the use of mental heal th specialty care and general medical care in the United States and th e Canadian province, Ontario. It also examines how lack of insurance c overage in the United States and perceived need for care affects diffe rences between the two countries. We employ a cross-sectional study de sign using the 1990 U.S. National Comorbidity Survey and the 1990 Ment al Health Supplement to the Ontario Health Survey. Overall, 8.8% of Am ericans report one or more visits to the health sector for a mental he alth problem, compared to 6.9% of Canadians in Ontario. Americans with the highest incomes and no mental morbidity are much more likely to r eceive services than their Canadian counterparts. By contrast, America ns with the lowest incomes and high morbidity are much less likely to receive services for mental health problems than a similar group of Ca nadians. These results suggest that universal and comprehensive covera ge, as exists in Ontario, does not necessarily lead to increased use o f services with low value. However, the greater prevalence of perceive d need for care among Americans with higher socioeconomic status and l ow mental morbidity suggests that the United States should be cautious in drawing lessons from other countries.