The purpose of this research was to investigate the
substitution of higher cost hospitalization for lower
cost outpatient specialty care for depression and the
extent to which insurance barriers impact service
substitution patterns of outpatient specialty care for
depression in rural and urban areas. The study found that
depressed rural patients were hospitalized more than
their urban counterparts over two years, with
statistically greater hospitalization rates at 6 months
and statistically greater length of stays at 12 months.
These differential hospitalization rates/lengths were not
explained by previous outpatient specialty care
treatment, which was comparable for rural and urban
patients. Insurance barriers predict reduced use of
specialty care in depressed urban patients, but not in
depressed rural patients.