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  1. Depressive symptoms and plan switching under managed care.

    Article - En anglais


    A central assumption underlying managed care is that plan switching is a viable option for enrollees when they are dissatisfied.

    The authors used a national employee survey to test the hypothesis that this mechanism is less effective for enrollees with high levels of depressive symptoms than for the remainder of the population.


    The study used data from the Employee Health Care Value Survey, a 1993 survey of 20,283 employees of three major corporations.

    The authors used the Medical Outcomes Study 36-Item Short-Form Health Survey to identify individuals with the highest decile of depressive and physical symptoms.

    They examined the relationship between symptoms and dissatisfaction and, for dissatisfied individuals, how symptoms predicted plan switching.

    Multivariate models were used to control for potential demographic, health, and health coverage confounders.


    Depressive and physical symptoms were both associated with dissatisfaction with care.

    Unlike physical symptoms, depressive symptoms were associated with a significantly lower likelihood of actually disenrolling among people who were dissatisfied or who intended to disenroll.

    This effect was most pronounced for satisfaction with administrative aspects of care (e.g., gatekeeping, utilization review).


    People with high levels of depressive symptoms appeared to be less willing or able to act on their dissatisfaction by switching plans. (...)

    Mots-clés Pascal : Etat dépressif, Soin intégré, Planification, Satisfaction, Utilisateur, Système santé, Etats Unis, Amérique du Nord, Amérique, Santé mentale, Homme, Trouble humeur

    Mots-clés Pascal anglais : Depression, Managed care, Planning, Satisfaction, User, Health system, United States, North America, America, Mental health, Human, Mood disorder

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0284526

    Code Inist : 002B18H05A. Création : 16/11/1999.