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Previous Volume 336:551-557 February 20, 1997 Number 8 Next

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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.

Source Information

From the Department of Health Care Policy, Harvard Medical School, Boston (R.C.K., R.G.F.); the School of Medicine and the Department of Health Services Management and Policy, School of Public Health (M.E.), and the Department of Internal Medicine, School of Medicine, and the Department of Health Services Management and Policy, School of Public Health (S.J.K.), University of Michigan, Ann Arbor; the Department of Psychiatry, University of Toronto, and the Health Systems Research Unit, Clarke Institute of Psychiatry, Toronto (E.L.); and the Department of Mental Hygiene, Johns Hopkins University, Baltimore (P.L.).

Address reprint requests to Dr. Kessler at the Department of Health Care Policy, Harvard Medical School, 25 Shattuck St., Parcel B, 1st Fl., Boston, MA 02115.

Full Text of this Article

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Psychiatric Outpatient Services in the United States and Canada
Gabbard G. O., Doidge N., Lazar S., Szul M., Szul M., Kessler R. C., Katz S. J., Lin E.
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