had not received psychological treatment, it was found that this comparison group had

higher health care utilization rates over time, in addition to a reduction in health care

utilization for the group receiving psychological treatment.

 Following the Follette and Cummings (1968) study, a series of cost-offset studies

were conducted. In 1984, two meta-analyses of the literature were published (Mumford

et al., 1984). One analysis was conducted on Blue Cross Blue Shield Federal Employee

Plan claims from 1974 to 1978, and the other analysis was conducted on 58 published

studies. The basic conclusion from these meta-analyses was that 85 percent of the studies

found a cost-offset effect, mainly observed in the reduction of inpatient days.

 In another meta-analysis of 91 studies from 1967 to 1997, 90 percent of the studies

reported a reduction in medical utilization following mental health interventions (Chiles,

Lambert, & Hatch, 1999). Twenty-eight articles reported dollar savings and 31 percent

reported savings after taking into account the cost of mental health treatment. Overall, a

savings of about 20 to 30 percent was reported across the articles. The effect was most

evident for behavioral medicine and psychoeducational interventions.

 Despite the evidence supporting the cost offset effect, several studies provide

evidence against the effect. The Medical Outcomes Study involved 22,000 outpatients

who were screened for several chronic medical conditions and these patients were

followed over time (Wells et al., 1996). One focus of the study was on the comparisons

between patients who received appropriate mental health treatment and those who had

not. The study produced no evidence of reduced inpatient or outpatient services. Instead,

cost-shifting occurred, in which the care received simply shifted from the patients'

general medical provider to a mental health provider.