Cited by 186Mental Health Treatment and AccessPsychiatric care and mental health servicesHealthcare Policy and Management

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Differences in the Use of Psychiatric Outpatient Services between the United States and Ontario

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Kessler, Ronald C., Frank, Richard G., Edlund, Mark, Katz, Steven J., Lin, Elizabeth, Leaf, Philip·1997·New England Journal of Medicine

DOI 10.1056/nejm199702203360806

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Abstract

BACKGROUND: The relation between health insurance and the use of mental health services is unclear. We compared the use of outpatient services for psychiatric problems in the United States and Ontario, Canada, among young and middle-aged adults according to self-reports of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) and to other indicators of need. METHODS: We analyzed two general-population surveys carried out separately in the United States and Ontario in 1990 that used identical assessments of need for services and questions about their use by persons 15 to 54 years of age. RESULTS: Respondents in the United States were significantly more likely than those in Ontario to report having had psychiatric disorders, poor mental health, or workdays lost or cut short because of psychiatric problems in the previous year. A significantly higher proportion of respondents in the United States (13.3 percent) than in Ontario (8.0 percent) had obtained outpatient treatment in the previous 12 months for psychiatric problems. However, an analysis of subgroups found that the higher probability of the use of services in the United States was confined to people with less severe mental illness. The average number of visits did not differ significantly between the two countries among patients who had similar numbers of psychiatric disorders over the same time periods. There was a stronger match in Ontario than in the United States between the use of services and the measures of perceived need we considered. CONCLUSIONS: Although the mental health care system in the United States provides treatment to a larger proportion of the population than that in Ontario, the match between some measures of need and treatment is not as strong in the United States. Any plans to expand coverage for psychiatric disorders in the United States must address this problem.

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Authors: Kessler, R. C., Frank, R. G., Edlund, M., Katz, S. J., Lin, E., & Leaf, P.
Affiliations: Harvard University (US)
University of Michigan (US)
Johns Hopkins University (US)
ORCID: Kessler, Ronald C.
Frank, Richard G.
Edlund, Mark
Katz, Steven J.
Lin, Elizabeth
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1997-02-20
Volume: 336
Issue: 8
Pages: 551-557
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199702203360806
OpenAlex: W2067766571
Cited by: 185
References: 25
Citations by year: 2024: 1 · 2023: 1 · 2022: 3 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 1 · 2014: 4 · 2013: 6 · 2012: 5
FWCI: 24.86
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
TSpace (University of Toronto) (submittedVersion)
Funders: National Institutes of Health (5r01mh052861-04)
National Institute of Mental Health (MH52861, MH-49098, MH46379, R01MH049098)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords: psychiatric outpatient services, mental health service utilization, health insurance coverage, mental illness severity, perceived need for mental health care, cross-national comparison, United States, Ontario, young and middle-aged adults, access to mental health care
MeSH terms: Adolescent, Adult, Ambulatory Care, Mental Disorders, Health Services Accessibility, Health Services Needs and Demand, Humans, Mental Health Services, Middle Aged, Ontario, United States, Health Care Surveys

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Differences in the Use of Psychiatric Outpatient Services between the United States and Ontario

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