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Kenneth B. Wells, MD, MPH; Willard G. Manning, Jr, PhD; R. Burciaga Valdez, PhD, MHSA

Arch Gen Psychiatry. 1989;46(4):315-320.

Abstract
• Reductions in the generosity of fee-for-service insurance lower the use of general medical and mental health services, but do they lead to lower mental health status for the covered population? We addressed this question using data from the RAND Corporation Health Insurance Experiment. Families in six sites in the United States were randomly assigned to one of 14 insurance plans for three- or five-year periods. On average, there were no significant adverse effects of cost-sharing plans, relative to a free-care plan, on either psychological well-being or psychological distress, when the cost-sharing plans included full catastrophic coverage. Those with high mental health status but low income at baseline had significantly more favorable mental health outcomes on the cost-sharing plans than on the free-care plan. We cannot definitively comment on the effects of insurance generosity for the sick poor. Our findings apply in the context of mandated comprehensive mental and general health coverage for a general nonelderly, nondisabled household population.

Author Affiliations
From The RAND Corporation, Santa Monica, Calif (Drs Wells, Manning, and Valdez); the Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute, and UCLA School of Medicine (Dr Wells); and the Division of Health Services, UCLA School of Public Health (Dr Valdez).

Footnotes
Accepted for publication July 29, 1988.

Reprint requests to The RAND Corporation, Santa Monica, CA 90406 (Dr Wells).

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