Managed care organizational complexity and access to high-quality mental health services: Perspective of U.S. primary care physicians

Benjamin W. Van Voorhees, Nae Yuh Wang, Daniel E. Ford

Research output: Contribution to journalArticle


This analysis addresses the relationship between perceived access to high-quality specialty mental health and medical services and 2 aspects of managed care organizational complexity at the practice level: 1) gatekeeper requirements for specialty services, and 2) managing multiple contracts. Cross-sectional analysis of a national telephone survey of 7,197 primary care physicians (PCPs) was performed. Access was defined as high-quality specialty services being always or almost always available to the PCP's patients when medically necessary. PCPs rated access to high-quality outpatient specialty mental health services as much lower than that of specialty medical services (28%; 95% confidence interval [CI], 27-29 versus 81%; 95% CI, 80-82). After adjustment for physician, practice, and managed care factors (multiple logistic regression analysis), perceived access to high-quality outpatient mental health services was lowest for practices with the largest number of managed care contracts and when a physician's practice was a "mixed model" with regard to the gatekeeper function. Perceived access to high-quality specialty medical services was not as strongly associated with these practice characteristics. PCPs who interact with a large number of managed care plans and different administrative models may have the most difficulty in obtaining high-quality mental health services for their patients.

Original languageEnglish (US)
Pages (from-to)149-157
Number of pages9
JournalGeneral Hospital Psychiatry
Issue number3
StatePublished - Jan 1 2003



  • Managed care
  • Mental health care services
  • Primary care
  • Psychiatric referrals
  • Quality of care

ASJC Scopus subject areas

  • Psychiatry and Mental health

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