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规则与相机抉择:美国青少年精神疾病的治疗

Rules versus Discretion: Treatment of Mental Illness in US Adolescents
Journal of Political Economy · 2025 · [{"name": "Emily Cuddy", "affiliation": []}, {"name": "Janet Currie", "affiliation": []}]

中文摘要

许多心理健康障碍始于青春期,适当的初始治疗可能改善其发展轨迹。但什么是适当的治疗?我们利用一个大型全国性保险理赔数据库,考察初始心理健康治疗对青少年子女随后两年结果的影响,其中治疗或符合美国食品药品监督管理局(FDA)指南,或符合专业协会发布的较宽松指南(灰色地带处方),或与任何指南均不一致(红旗处方)。我们发现,红旗处方会增加自伤、急诊室使用和医疗保健成本,这表明治疗指南在实践中有效地推广了良好治疗。

Abstract

Many mental health disorders start in adolescence, and appropriate initial treatment may improve trajectories. But what is appropriate treatment? We use a large national database of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next 2 years, where treatment is either consistent with US Food and Drug Administration guidelines, consistent with looser guidelines published by professional societies (gray area prescribing), or inconsistent with any guidelines (red-flag prescribing). We find that red-flag prescribing increases self-harm, use of emergency rooms, and health care costs, suggesting that treatment guidelines effectively scale up good treatment in practice.
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