This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (59)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Psychiatry, Other  • Alert me on articles by topic

A Comparison of the United States With Ontario and the Netherlands

Margarita Alegría, PhD; Rob V. Bijl, PhD; Elizabeth Lin, PhD; Ellen E. Walters, MS; Ronald C. Kessler, PhD

Arch Gen Psychiatry. 2000;57:383-391.

Background  Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data from 3 countries that differ in the organization and financing of mental health services.

Methods  Data come from the 1990-1992 National Comorbidity Survey (n=5384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n=6321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n=6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector.

Results  No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle-income bracket are less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario.

Conclusions  Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.

From the Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan (Dr Alegría); the Psychiatry Epidemiology Unit, Netherlands Institute of Mental Health and Addiction, Utrecht (Dr Bijl); the Department of Psychiatry, University of Toronto, and the Health Systems Research and Consulting Unit, the Center for Addiction and Mental Health, Toronto, Ontario (Dr Lin); and the Department of Health Care Policy, Harvard Medical School, Boston, Mass (Ms Walters amd Dr Kessler).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Regional variations and determinants of direct psychiatric costs in Sweden
Tiainen et al.
Scand J Public Health 2008;36:483-492.
ABSTRACT  

Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands
Sareen et al.
Psychiatr. Serv. 2007;58:357-364.
ABSTRACT | FULL TEXT  

Differences in Lifetime Use of Services for Mental Health Problems in Six European Countries
Kovess-Masfety et al.
Psychiatr. Serv. 2007;58:213-220.
ABSTRACT | FULL TEXT  

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?
Vasiliadis et al.
Psychiatr. Serv. 2007;58:63-71.
ABSTRACT | FULL TEXT  

Financing mental health services in low- and middle-income countries
Dixon et al.
Health Policy Plan 2006;21:171-182.
ABSTRACT | FULL TEXT  

Inequity in Mental Health Care Under Canadian Universal Health Coverage
Steele et al.
Psychiatr. Serv. 2006;57:317-324.
ABSTRACT | FULL TEXT  

Inequities in Mental Health Care After Health Care System Reform in Chile
Araya et al.
Am. J. Public Health 2006;96:109-113.
ABSTRACT | FULL TEXT  

The Cornell Service Index as a Measure of Health Service Use
Sirey et al.
Psychiatr. Serv. 2005;56:1564-1569.
ABSTRACT | FULL TEXT  

Demand for Mental Health Care and Changes in Service Use Patterns in the Netherlands, 1979 to 1995
ten Have et al.
Psychiatr. Serv. 2005;56:1409-1415.
ABSTRACT | FULL TEXT  

The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients
Zimmerman et al.
Am. J. Psychiatry 2005;162:1911-1918.
ABSTRACT | FULL TEXT  

Socio-economic inequalities in suicide: a European comparative study
LORANT et al.
Br. J. Psychiatry 2005;187:49-54.
ABSTRACT | FULL TEXT  

Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys
The WHO World Mental Health Survey Consortium
JAMA 2004;291:2581-2590.
ABSTRACT | FULL TEXT  

The Role Of Public Policies In Reducing Mental Health Status Disparities For People Of Color
Alegria et al.
Health Aff (Millwood) 2003;22:51-64.
ABSTRACT | FULL TEXT  

Socioeconomic Inequalities in Depression: A Meta-Analysis
Lorant et al.
Am J Epidemiol 2003;157:98-112.
ABSTRACT | FULL TEXT  

Mental Health Care for Latinos: Inequalities in Use of Specialty Mental Health Services Among Latinos, African Americans, and Non-Latino Whites
Alegria et al.
Psychiatr. Serv. 2002;53:1547-1555.
ABSTRACT | FULL TEXT  

Use, Quality, and Outcomes of Care for Mental Health: The Rural Perspective
Rost et al.
Med Care Res Rev 2002;59:231-265.
ABSTRACT  

Equity in prevention and health care
Lorant et al.
J. Epidemiol. Community Health 2002;56:510-516.
ABSTRACT | FULL TEXT  

Patterns of Use of Ambulatory Mental Health Services in a Universal Care Setting
Bovier et al.
Psychiatr. Serv. 2001;52:1515-1520.
ABSTRACT | FULL TEXT  

Shortfall in mental health service utilisation
ANDREWS et al.
Br. J. Psychiatry 2001;179:417-425.
ABSTRACT | FULL TEXT  

Prevalence of Psychotic Disorder and Community Level of Psychotic Symptoms: An Urban-Rural Comparison
van Os et al.
Arch Gen Psychiatry 2001;58:663-668.
ABSTRACT | FULL TEXT  

The Distribution of Psychiatric and Somatic Ill Health: Associations With Personality and Socioeconomic Status
Neeleman et al.
Psychosom. Med. 2001;63:239-247.
ABSTRACT | FULL TEXT