Outpatient Health Service Utilization Research Articles

Outpatient health service utilization and associated factors: a population-based study.

To identify factors that lead people to visit a doctor in Brazil and assess differences between socioeconomic groups. A cross-sectional study comprising 1,260 subjects aged 15 or more was carried out in southern Brazil. Demographic, socioeconomic, health needs and regular source of care data were analyzed concerning visits to a doctor within two months from the interview. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression. Adjusted PR showed that women having stressful life events, health insurance, and a regular doctor increased the outcome. A dose-related response was found with self-reported health, and the probability of visiting a doctor increased with health needs. Analysis in the chronic disease group revealed that uneducated lower income subjects had a 62% reduction in the chance of visiting a doctor compared to uneducated higher income ones. However, as it was seen a significant interaction between income and education, years of schooling increased utilization in this group. Results suggest the existence of health inequity in the poorest group that could be overcome with education. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved group.

Hospital and Outpatient Health Services Utilization Among HIV-Infected Patients in Care in 1999

Hospital and Outpatient Health Services Utilization Among HIV-Infected Patients in Care in 1999

Hospital and outpatient health services utilization among HIV-infected patients in care in 1999.

The evolving epidemiology and therapeutic management of HIV disease has important implications for health care resource utilization in HIV-infected patients, and health care resource use data are also needed to support policy and financial decision making. Demographic, clinical, and resource utilization data were collected from 9 U.S. HIV primary and specialty care sites in calendar year 1999. Rates of resource use were calculated for hospital admission, length of hospital stay, and outpatient clinic/office visits. The sample included 5255 patients from HIV primary care sites in 3 eastern, 3 midwestern, and 3 western areas of the United States. Hospital admissions accounted for an annual mean of 297 days per 100 persons/y in 1999. Hospital days ranged from a low of 165 per 100 persons/mo for a CD4 > 500 cells/mm(3) to 840 per 100 persons/mo for a CD4 < 50 cells/mm(3) (p <.01). Mean annual outpatient clinic/office visits were 10.7 per person in 1999. A declining CD4 level and an increasing HIV-1 RNA level were both associated with higher hospital and outpatient utilization. HAART use was associated with fewer hospital days, and a higher outpatient visit rate. Injecting drug use risk was associated with an increase in hospital days. African American race was associated with a higher number of hospital days, but a lower outpatient visit rate. Female gender was associated with higher outpatient utilization. Mean monthly inpatient and outpatient expenditures in 1999 were $423 and $168, respectively. As HIV care continues to evolve, data from our network of HIV providers will be useful in quantifying changes in HIV health services utilization to guide policy makers, as well as HIV care payers and providers.

Medicare's Mental Health Coverage

Back to table of contents Previous article Next article LetterFull AccessMedicare's Mental Health CoverageMaureen Mickus, Ph.D., Christopher Colenda, M.D., and Andrew Hogan, Ph.D.Maureen MickusSearch for more papers by this author, Ph.D., Christopher ColendaSearch for more papers by this author, M.D., and Andrew HoganSearch for more papers by this author, Ph.D.Published Online:1 Aug 2000https://doi.org/10.1176/appi.ps.51.8.1050-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: Dr. Hennessy's main criticism focuses on our view that payment restrictions for mental health services under Medicare can have serious consequences for patients. Despite important strides toward parity in mental health coverage under Medicare since the 1980s, spending in this area remains relatively low, highlighting the deficiencies in the system. For example, Medicare places lifetime limits on inpatient days for mental disorders treated in psychiatric hospitals but not in general hospital settings. Exempting one type of facility but not another from lifetime coverage is clinically arbitrary at best and adversely affects utilization of needed services at worst.Our greatest concern is that Medicare provides only 50 percent coverage for psychotherapy services, a serious disparity with general medical services. Studies have demonstrated that higher prices decrease utilization of outpatient mental health services compared with other outpatient services (1,2). It is apparent that this level of coverage serves as strong incentive for underutilization of outpatient psychotherapy by older individuals, particularly those on fixed incomes without supplementary coverage. This benefit structure not only provides a striking disincentive for comprehensive treatment, but it also ignores the efficacy of psychotherapy coupled with medication in treating late-life psychiatric illnesses, particularly affective disorders (3).Dr. Hennessy concludes that Medicare cost limitations do not necessarily represent a serious deterrent to care on the basis of our finding that 80 percent of respondents age 65 and over would choose to receive mental health care from a primary care physician or psychiatrist. However, the fact that an individual is able to identify a provider for care does not ensure that he or she will actually receive the most appropriate care in terms of quality, amount, or specificity.In light of the U.S. Surgeon General's recent report indicating that half of Americans who have a severe mental illness do not seek treatment (4), we believe that any gaps in benefits could have significant ramifications for individuals as well as for society. Thus we stand by our original conclusion that the disparities in Medicare coverage of mental health services are significant and may induce underutilization of necessary services to the detriment of those in need of care.

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.

Administrative update: utilization of services. II. Utilization of mental health services in a tri-ethnic sample of adolescents.

In our study of a tri-ethnic sample of 2528 junior and high school students, we examined utilization of outpatient mental health services in relation to a number of variables cited in the literature as leading to potential biases and barriers to care. These include: age, gender, ethnicity, socioeconomic status, family size and composition, and linguistic fluency in Hispanic youth. The impact of service availability was examined through differences between the two regions studied: a well-served region of coastal southeast Texas and the markedly under served lower Rio Grande Valley. The impact of symptomatology was evaluated using the total problem score on the Youth Self Report by Achenbach. Hispanic youth had significantly lower mean service utilization than non-Hispanic whites. Multiple regression analyses demonstrated that socioeconomic status and family composition had a greater relative impact on utilization than all other non-clinical factors, both for the total sample as well as for the Hispanic sample. Ethnicity may play a significant role in child mental health services utilization through its close association to socioeconomic status.

Consequences of adult HIV infection for outpatient morbidity and treatment costs: a prospective study in a factory clinic in Tanzania.

Most studies of the medical costs of HIV infection focus on the terminal stage of this chronic illness when the patients have developed AIDS or severe HIV disease and in-patient care dominates. Data are also needed on the medical costs during the prolonged phase of HIV infection preceding severe terminal illness and the effects it may have on the provision of outpatient care. The study population was derived from a cohort study of factory workers and their spouses in Tanzania. Morbidity and outpatient health services utilization are estimated for 1832 adults who on average had been enrolled for two years and utilized the study clinic. Among those who had been enrolled at least 2 years, 50 cases (HIV+ since enrollment) and 150 control (HIV- until last visit) were selected, matched by age, sex and income level to estimate expenditure on drugs by HIV status. There was an increase in morbidity during HIV infection: the incidence of clinical diagnoses was 30% higher among HIV-positive than among HIV-negative adults (p < 0.001). HIV-infected adults also made more frequent use of the outpatient services (23% higher utilization). Estimates of essential drug costs among the subsample showed a 15% increase for HIV infected adults compared to HIV-negative adults, caused by higher use of antibiotics and other antimicrobial drugs. The overall increase in morbidity, outpatient care services utilization and essential drug use due to HIV infection was limited, as HIV prevalence in this adult population was 11%. For example, the net proportion of all illness episodes attributable to HIV infection was 3.2%. Possible biases are discussed and suggest that our findings are a minimum estimate of the effect of adult HIV infection on outpatient care costs. There is a need for more studies in different settings to assess the impact of HIV infection on outpatient care in developing countries.

Use of RN case management and costs and utilization of outpatient mental health services: a pilot study.

The majority of outcome studies on case management seem to have been studied on the chronically mentally ill patients. Little is known regarding the use of a case management approach with general psychiatric populations, which include non-chronically mentally ill patients in an outpatient setting. This study examined the effect of a registered nurse case management (RNCM) model on the delivery and cost of mental health services during an 18-month period for clients in an outpatient psychiatric setting. Sixty clients met the criteria for sample selection. The data indicated that the use of the RNCM model resulted in more nursing than psychiatric care. Despite more frequent visits to the RNCM and longer RNCM visits, RNCM services appeared cost effective and were related to decreased length of hospital stay. A subgroup of high-risk clients was identified, and a significantly greater use of services by this group was substantiated.

Asian Americans' differential patterns of utilization of inpatient and outpatient public mental health services in Hawaii

The major purpose of the present study was to examine Asian Americans' differential patterns of utilization of mental health services in Hawaii. It was proposed that an analysis of Asian Americans' differential patterns of utilization of inpatient and outpatient mental health services may provide some clues to the reasons behind their overall pattern of underutilization. More specifically, whereas it has been established in many studies that Asian Americans tend to underutilize mental health services, the present research questions are directed at determining if Asian Americans tend to (a) underutilize inpatient mental health services, (b) overutilize or use at their representative level outpatient mental health services, and (c) exhibit different patterns in the sources of referral into the mental health system. Using a dataset from the state of Hawaii's Department of Health, mental health service utilization rates for three Asian-American groups (Chinese, Japanese, and Filipino) were compared to each other and to those of White Americans. It was found that there were ethnic subgroups (e.g., Chinese versus Filipino) and intergroup differences (i.e., Asian versus White) in the utilization of inpatient and outpatient mental health services as well as in sources of referral into the mental health system. The clinical and research implications of the findings are discussed.

Patterns of utilization of outpatient mental health services by children and adolescents.

Although as many as one-fifth of children and adolescents may meet DSM-III criteria for at least one psychiatric diagnosis, data from the Minnesota Department of Human Services for 1988 show that only 20 to 38 percent of children and adolescents in the state who are eligible for medical assistance and who are potentially in need of psychiatric care are referred for or seek treatment. A study of publicly funded mental health care for youths under 18 found that in 1988 the average cost for state-supported psychiatric services per outpatient case was $520, compared with $8,556 per inpatient case. However, overall cost of state-supported mental health services for youths under 18 increased by 28 percent between 1987 and 1988, primarily due to increases in payments for inpatient care of patients with dual diagnoses of mental illness and chemical dependency.

Utilization of outpatient mental health services after inpatient alcoholism treatment.

It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients to achieve long-term recovery. However, the quantity and duration of utilization of such services in non-experimental settings are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment and 1,860 alcoholics discharged from brief inpatient hospitalizations in Department of Veterans Affairs medical centers. Weekly use of outpatient mental health services (OPMH) prior to hospital admission was equally low for both patient groups (approximately 2-3% of patients) until four weeks prior to admission, at which time OPMH use increased, particularly for the extended treatment group. In the four weeks after discharge, use of OPMH services was substantially higher for patients with extended treatment compared to those with brief hospitalizations (40% vs. 18%), with 22% of patients completing treatment utilizing such services in the first week after discharge. Utilization steadily decreased until only 8% and 4% of both groups, respectively, were using OPMH services at the end of six months after discharge. Study results suggest the need to examine barriers to outpatient mental health utilization after discharge as well as interventions to increase compliance with long-term aftercare.

Utilization of Outpatient Health Services by Army Retirees and Spouses

To determine the sources and volumes of outpatient care used by one group of military beneficiaries, a data collection tool entitled the Outpatient Health Care Survey was developed and mailed to 496 Army retirees in southern Texas. This article details the results of that survey based on responses from 262 Army retirees and spouses.

Determinants of Inpatient Mental Health Use in a Heavily Insured Population

This paper estimates a model of the demand for hospital inpatient mental health services. It uses data on enrollees who were in the Blue Cross and Blue Shield Association Federal Health Benefits Plan from 1979 to 1981. The econometric analysis focuses on the impact of increased copayments and deductibles in the highoption plan. The results provide evidence that increases in outpatient copayments and deductibles reduce the utilization of both inpatient and outpatient mental health services. Of interest is the negative income elasticity of demand for hospital inpatient services and the positive association between the relative availability of mental health providers and the demand for mental health care.

Enhancing the utilization of outpatient mental health services.

This article describes two sets of field studies undertaken by the program evaluation unit of a community mental health center. These studies analyzed clients' utilization of service and assessed service impact in the process of testing procedural variations in service delivery. In the first set of studies, a procedure for ensuring verbal client-therapist contact prior to the first appointment was developed and tested. This procedure reduced the no-show rate for initial appointments from 22 to 12%. In the second set of studies, a brief pretherapy orientation nearly eliminated dropout during the first month of therapy. Orientation had both short- and long-range impact on the amount of services used by clients as well as on their outcomes. Therapist's global ratings of client functioning reflected more change for oriented clients, who reported greater short-term symptom reduction as well. Non-oriented clients were more likely to drop out early and to impress their therapists less favorably. The results of these studies suggest that a combination of pretherapy orientation and verbal client-therapist contact prior to the initial appointment might greatly reduce the failure to complete treatment.