Persons who suffer from mental illness consume a disproportionate—and some maintain an inappropriate—amount of general (somatic) health services. Many mental health care providers assert that the timely treatment of mental illness will generate a subsequent reduction in the use of non-mental health care. Although this alleged phenomenon—termed the medical offset effect—has been intensively studied for two decades, these efforts have not produced anything approaching a consensus concerning the very existence of the effect. Different definitions and measures of the concept, different experimental designs, different research agendas, methodologies, and statistical techniques have contributed to researchers more often than not "talking past" one another. Furthermore, the findings of the overwhelming majority of offset studies have been vitiated by a variety of methodological shortcomings. Most of these shortcomings share a common etiology: the failure of researchers to explicitly either describe or analyze the behavioral foundations of the relationships they are trying to observe and measure. Research efforts have been largely devoted to identifying factors associated with the offset, rather than explaining the offset.
In this article we develop a behavioral model for explaining the medical offset and providing (a priori) justification for positing particular relationships and, concomitantly, selecting and analyzing particular variables for study. This approach holds greater promise for enabling future research to incrementally advance our knowledge and understanding of the complex behavioral processes involved in the medical offset effect.
Fiedler, John L. and Jonathan B. Wight. 1986. "A Behavioral Model of the Medical Offset Effect." E.C.R.S.B. 86-9. Robins School of Business White Paper Series. University of Richmond, Richmond, Virginia.