The treatment of women with mental health disorders under HMO and fee-for-service insurance

The expansion of managed care may have significant implications for the treatment of women with mental health problems seen in primary care and by specialty mental health practitioners. Using data on office visits by women with mental health problems from the 1990-1994 annual National Ambulatory Medical Care Survey, we examine characteristics of office visits by payment type. We find that women with HMO-paid visits are much more likely to see a primary care practitioner rather than a specialist. While treatment patterns in primary care do not differ by payment type, treatment patterns in specialty care differ substantially. Women in HMOs are mole likely to receive medications and less likely to receive psychotherapy, particularly longer duration psychotherapy, than are those with FFS payment.