Provider Choice and Continuity for the Treatment of Depression

by Roland Sturm, Lisa S. Meredith, Kenneth B. Wells

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The role of specialist versus generalist providers regularly surfaces in health care reform debates about costs and quality of care. By changing incentives to seek and deliver care, different payment systems can affect both the probability of initial specialty care and the duration of this patient-provider relationship. This paper compares provider selection (psychiatrist, non-MD mental health specialist, general medical provider) and the duration of this relationship among depressed patients in prepaid and fee-for-service plans. Regarding initial care, depressed patients in prepaid plans are significantly less likely to see a psychiatrist and more likely to see a non-MD mental health specialist than patients in fee-for-service plans. Although the mix of providers differs, patient demographic and clinical characteristics have similar effects on specialty in both payment systems, i.e., there are no differences in who gets specialty care by type of payment, but in how many get specialty care. The average duration of a patient-provider relationship is significantly shorter in prepaid plans. Durations are significantly shorter for patients of both psychiatrists and general medical providers in prepaid plans, but do not differ by payment type for non-MD therapists. In both payment systems, patients of non-MD providers end the relationship sooner than patients of psychiatrists or general medical providers. Although we find provider switching to be significantly associated with discontinuing antidepressant medication, there is no significant direct effect on patient health outcomes.

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