The Effects of a Prepaid Group Practice on Mental Health Outcomes of a General Population

Results from a Randomized Trial

by Kenneth B. Wells, Willard G. Manning, R. Burciaga Valdez


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Prepaid group practices deliver less outpatient mental health care than do comparable fee-for-service plans. This difference raises the question whether participants enrolled in a prepaid group practice have different mental health outcomes than participants enrolled in fee-for-service plans. To answer this question, the authors used data from a randomized trial, the RAND Health Insurance Experiment. The study randomly assigned Seattle families to either a prepaid group practice — the Group Health Cooperative of Puget Sound (GHC) — or to one of several fee-for-service insurance plans that varied in the amount of cost sharing required. They observed no statistically significant or clinically meaningful differences in general mental health outcomes between persons enrolled in the GHC and fee-for-service plans. In addition, no insurance-plan-related differences were observed for populations of special interest, including those with initially low mental health scores and/or low incomes. Thus, the less intensive style of mental health treatment in the prepaid group practice is not associated with noticeable adverse effects on general mental health status.

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