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Health Care Costs and Financing

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Patients suffering from depression often overestimate their insurance coverage for mental health services

People's understanding of their health care coverage can influence whether they seek care for their health problems. For example, high copays or strict limits on visits and other types of health care services may dissuade them from seeking care, while low copays or unlimited visits may have the opposite effect.

Apparently, patients suffering from depression often perceive more generous mental health coverage than they actually have, which could lead to unexpected out-of-pocket costs. In contrast, patients usually have a fairly accurate idea of their coverage for medical visits and prescription copays, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS08349).

More effective dissemination of information about mental health benefits by health maintenance organizations, health care plans, and employers could correct misperceptions, enhance trust, and improve access to and quality of mental health care, according to the researchers who conducted the study. Their findings were based on analysis of data from 767 depressed patients who completed a mailed survey that included questions about health insurance. The researchers compared their responses with actual health care benefits records of medical visits, pharmacy and mental health visit copays, and mental health visit limits.

Overall, depressed patients reported better mental health benefits than they actually had. Depressed patients who had used health care services in the past 6 months had a more accurate picture of medical benefits but not of mental health benefits. Patients with depressive disorder and patients who were less satisfied with their health care more accurately reported mental health copays compared with those who had depression symptoms only and more satisfied patients, respectively. Also, white patients and patients who had fewer chronic health problems were more accurate in reporting mental health visit limits than ethnic/minority and sicker patients.

More details are in "Knowledge of health care benefits among patients with depression," by Lisa S. Meredith, Ph.D., Nicole Humphrey, M.H.S.A., Maria Orlando, Ph.D., and Patti Camp, M.S., in the April 2002 Medical Care 40(4), pp. 338-346.

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