Does affordability affect mental health utilization? A United States-Israel comparison of older adults

The affordability of treatment is considered a major influence on the utilization of mental health services, a premise empirically examined in this research. Utilization patterns in the U.S. are compared with Israel, a country where access to treatment is not influenced by costs and their coverage. The focus is primarily on older adults, whose consistently low use of ambulatory services (in U.S.) has been attributed to financial barriers. The findings challenge the affordability-utilization assumption: (1) older Israeli ambulatory use is lower than in the U.S.; (2) Israeli elders have the lowest rates of all adult groups, the same pattern as in the U.S.; (3) older Israelis have a substantially higher inpatient rate than younger Israelis (< 65), a pattern dissimilar from the U.S. These findings have important implications for policymakers who attempt to address underserved groups by reducing financial barriers. Israeli data provide compelling evidence that affordability may be less relevant to mental health than to other health services. A more promising research focus is on those organizational, professional and other structural factors which shape the system and influence how, where, and to whom treatment is provided.