Skip to main content

Advertisement

SpringerLink
Log in

General medical and pharmacy claims expenditures in users of behavioral health services

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists.

DESIGN: Retrospective cost trends and 24-month cohort analyses.

SETTING: A Midwest health plan.

PARTICIPANTS: Over 250,000 health plan enrollees during 2000 and 2001.

MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications.

MAIN RESULTS: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted.

CONCLUSIONS: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Garnick DW, Horgan CM, Hodgkin D, et al. Risk transfer and account-ability in managed care organizations’ carve-out contracts. Psychiatr Serv. 2001;52:1502–9.

    Article  PubMed  CAS  Google Scholar 

  2. Grazier KL, Eselius LL. Mental health carve-outs: effects and implications. Med Care Res Rev. 1999;56(suppl 2):37–59.

    PubMed  Google Scholar 

  3. Escobar JI, Golding JM, Hough RL, Karno M, Burnam MA, Wells KB. Somatization in the community: relationship to disability and use of services. Am J Public Health. 1987;77:837–40.

    Article  PubMed  CAS  Google Scholar 

  4. Harlow K, Johnson R, Callen P. Comparison of physical health benefits utilization. Mental and physical health claimants, 1989 and 1990. J Occup Med. 1993;35:275–81.

    PubMed  CAS  Google Scholar 

  5. Hansson L, Persson KB, Borgquist L. Patients with mental illness in primary health care. A long-term follow-up of health care utilization and contact patterns with psychiatric care. Scand J Prim Health Care. 1997;15:129–33.

    Article  PubMed  CAS  Google Scholar 

  6. Rost K, Zhang M, Fortney J, Smith J, Smith GR Jr. Expenditures for the treatment of major depression. Am J Psychiatry. 1998;155:883–8.

    PubMed  CAS  Google Scholar 

  7. Meerding WJ, Bonneux L, Polder JJ, Koopmanschap MA, van der Maas PJ. Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study. BMJ. 1998;317:111–5.

    PubMed  CAS  Google Scholar 

  8. Simon GE, Unutzer J. Health care utilization and costs among patients treated for bipolar disorder in an insured population. Psychiatr Serv. 1999;50:1303–8.

    PubMed  CAS  Google Scholar 

  9. Druss BG, Rosenheck RA. Patterns of health care costs associated with depression and substance abuse in a national sample. Psychiatr Serv. 1999;50:214–8.

    PubMed  CAS  Google Scholar 

  10. Katon WJ, Lin E, Russo J, Unutzer J. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry. 2003;60:897–903.

    Article  PubMed  Google Scholar 

  11. Hunkeler EM, Spector WD, Fireman B, Rice DP, Weisner C. Psychiatric symptoms, impaired function, and medical care costs in an HMO setting. Gen Hosp Psychiatry. 2003;25:178–84.

    Article  PubMed  Google Scholar 

  12. Goetzel RZ, Anderson DR, Whitmer RW, Ozminkowski RJ, Dunn RL, Wasserman J. The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. The Health Enhancement Research Organization (HERO) Research Committee. J Occup Environ Med. 1998;40:843–54.

    Article  PubMed  CAS  Google Scholar 

  13. Druss BG, Rohrbaugh RM, Rosenheck RA. Depressive symptoms and health costs in older medical patients. Am J Psychiatry. 1999;156:477–9.

    PubMed  CAS  Google Scholar 

  14. Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25:464–70.

    Article  PubMed  Google Scholar 

  15. International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, U.S. Department of Health and Human Services; 1988.

    Google Scholar 

  16. U.S. Department of Labor: Bureau of Labor Statistics. Consumer Price Index. Available at: http://www.bls.gov/bls/inflation.htm. Accessed December 20, 2002.

  17. Canaud M-C, Huber M, Lafortune G, Cerf KL, Morgan D, Thompson A. OECD Health Data 2002: A Comparative Analysis of 30 Countries. 4th ed. Paris: Organisation for Economic Cooperation and Development; 2002.

    Google Scholar 

  18. Lumley T, Diehr P, Emerson S, Chen L. The importance of the normality assumption in large public health data sets. Ann Rev Public Health. 2002;23:151–69.

    Article  Google Scholar 

  19. Hansen MS, Fink P, Frydenberg M, Oxhoj ML. Use of health services, mental illness, and self-rated disability and health in medical inpatients. Psychosom Med. 2002;64:668–75.

    Article  PubMed  Google Scholar 

  20. Fischer LR, Wei F, Rolnick SJ, et al. Geriatric depression, antidepressant treatment, and healthcare utilization in a health maintenance organization. J Am Geriatr Soc. 2002;50:307–12.

    Article  PubMed  Google Scholar 

  21. Koenig HG, Kuchibhatla M. Use of health services by hospitalized medically ill depressed elderly patients. Am J Psychiatry. 1998;155:871–7.

    PubMed  CAS  Google Scholar 

  22. Druss BG, Rosenheck RA, Sledge WH. Health and disability costs of depressive illness in a major U.S. corporation. Am J Psychiatry. 2000;157:1274–8.

    Article  PubMed  CAS  Google Scholar 

  23. Savoca E. Psychiatric co-morbidity and hospital utilization in the general medical sector. Psychol Med. 1999;29:457–64.

    Article  PubMed  CAS  Google Scholar 

  24. Cuffel BJ, Goldman W, Schlesinger H. Does managing behavioral health care services increase the cost of providing medical care? J Behav Health Serv Res. 1999;26:372–80.

    Article  PubMed  CAS  Google Scholar 

  25. Rosenheck RA, Druss B, Stolar M, Leslie D, Sledge W. Effect of declining mental health service use on employees of a large corporation. Health Aff (Millwood). 1999;18:193–203.

    Article  CAS  Google Scholar 

  26. Trudeau JV, Deitz DK, Cook RF. Utilization and cost of behavioral health services: employee characteristics and workplace health promotion. J Behav Health Serv Res. 2002;29:61–74.

    Article  PubMed  Google Scholar 

  27. Buck JA, Teich JL, Bae J, Dilonardo J. Mental health and substance abuse services in ten state Medicaid programs. Adm Policy Ment Health. 2001;28:181–92.

    Article  PubMed  CAS  Google Scholar 

  28. Buck JA, Teich JL, Miller K. Use of mental health and substance abuse services among high-cost Medicaid enrollees. Adm Policy Ment Health. 2003;31:3–14.

    Article  PubMed  Google Scholar 

  29. Rost K, Smith R, Matthews DB, Guise B. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med. 1994;3:333–7.

    Article  PubMed  CAS  Google Scholar 

  30. Waxman HM, McCreary G, Weinrit RM, Carner EA. A comparison of somatic complaints among depressed and non-depressed older persons. Gerontologist. 1985;25:501–7.

    PubMed  CAS  Google Scholar 

  31. Passamonti M, Pigni M, Fraticelli C, Calori G, Piccinelli M. Somatic symptoms and depression in general practice in Italy. Eur J Gen Pract. 2003;9:66–7.

    Article  PubMed  Google Scholar 

  32. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341:1329–35.

    Article  PubMed  CAS  Google Scholar 

  33. Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12:34–43.

    Article  PubMed  Google Scholar 

  34. Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ. Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry. 1993;150:734–41.

    PubMed  CAS  Google Scholar 

  35. Katon W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry. 1996;57(suppl 10):11–8; discussion 19–22.

    PubMed  Google Scholar 

  36. Khan AA, Khan A, Harezlak J, Tu W, Kroenke K. Somatic symptoms in primary care: etiology and outcome. Psychosomatics. 2003;44:471–8.

    Article  PubMed  Google Scholar 

  37. Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med. 1993;153:2474–80.

    Article  PubMed  CAS  Google Scholar 

  38. Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med. 2001;134(pt 2):917–25.

    PubMed  CAS  Google Scholar 

  39. Morris JA Jr, Carrillo Y, Jenkins JM, et al. Surgical adverse events, risk management, and malpractice outcome: morbidity and mortality review is not enough. Ann Surg. 2003;237:844–51; discussion 851–2.

    Article  PubMed  Google Scholar 

  40. Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000;38:261–71.

    Article  PubMed  CAS  Google Scholar 

  41. Brennan TA. The Institute of Medicine report on medical errors—could it do harm? N Engl J Med. 2000;342:1123–5.

    Article  PubMed  CAS  Google Scholar 

  42. Merrick EL, Garnick DW, Horgan CM, Goldin D, Hodgkin D, Sciegaj M. Benefits in behavioral health carve-out plans of Fortune 500 firms. Psychiatr Serv. 2001;52:943–8.

    Article  PubMed  CAS  Google Scholar 

  43. Goldman W, McCulloch J, Sturm R. Costs and use of mental health services before and after managed care. Health Aff (Millwood). 1998;17:40–52.

    Article  CAS  Google Scholar 

  44. Scheffler RM. Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture. J Ment Health Policy Econ. 1999;2:21–8.

    Article  PubMed  Google Scholar 

  45. Matevia ML, Poon D, Goldman W, Cuffel B, McCulloch J. Access to network clinicians in a managed behavioral health organization. Psychiatr Serv. 2001;52:1428.

    Article  PubMed  CAS  Google Scholar 

  46. U.S. General Accounting Office. Private Health Insurance. Access to Individual Market Coverage May Be Restricted for Applicants with Mental Disorders. Report No. GAO-02-339. Washington, DC: U.S. General Accounting Office; 2002.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA

    Roger G. Kathol MD & Terence Bernhardt BA

  2. Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA

    Roger G. Kathol MD, Yasuhiro Kishi MD, PhD & William Meller MD

  3. Department of Public Health, University of Minnesota, Minneapolis, MN, USA

    Donna McAlpine PhD

  4. Blue Cross Blue Shield of Minnesota, Eagan, MN, USA

    Robert Spies BMath, Keith Folkert MD & William Gold MD

  5. Phoenix Healthcare Intelligence, Eagan, MN, USA

    Steven Eisenberg MD

Authors
  1. Roger G. Kathol MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donna McAlpine PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuhiro Kishi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Spies BMath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William Meller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Terence Bernhardt BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven Eisenberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keith Folkert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. William Gold MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roger G. Kathol MD.

Additional information

Three of the coauthors, Robert Spies, Keith Folkert, and William Gold, are employees of Blue Cross Blue Shield of Minnesota. While Blue Cross is currently in the process of identifying ways to better address behavioral health needs for their enrollees, in part due to the results reported in this manuscript, none of these coauthors or Blue Cross Blue Shield of Minnesota anticipate direct or indirect benefit from the publication of this article.

The corresponding author. Roger G. Kathol, worked for Blue Cross Blue Shield of Minnesota as medical director at the time the data were collected and initial analyses were performed. He now works as a medical management consultant, addressing issues of health care coordination and could, therefore, indirectly benefit by the publication of this manuscript because it reports data related to the interaction of general medical and behavioral health care service use.

The remainder of the authors do not have direct or indirect conflicts of interest.

This manuscript is derived from routine claims analyses by the Cost Trends Committee at Blue Cross Blue Shield of Minnesota.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kathol, R.G., McAlpine, D., Kishi, Y. et al. General medical and pharmacy claims expenditures in users of behavioral health services. J GEN INTERN MED 20, 160–167 (2005). https://doi.org/10.1111/j.1525-1497.2005.40099.x

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2005.40099.x

Key words

Search

Navigation