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All Prepaid Health Care Systems Are Not Equal

Abby L. Wasserman, MD
Arch Gen Psychiatry. 1994;51(12):1002. doi:10.1001/archpsyc.1994.03950120074013.
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The article by Rogers et al1 concerning the different outcomes of adults with depression as a function of their means of payment raises many questions in trying to account for the discrepancy seen in psychiatrists' patients receiving fee-for-service (FFS) or prepaid (PP) care.

The major question that needs answering to evaluate this study is how the mental health program was managed compared with the FFS program. Were case managers evaluating the treatment along with the caregivers? Were any limitations placed on the caregivers, especially the psychiatrists, as to what they could or could not do? Were there limitations as to the number of visits or length of time per visit? Unless one knows the differences between the programs, the difference in outcomes is meaningless.

Since those with no insurance were included in the FFS group, how much did their presence lower the median income? In general, was this group of


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