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.
integrated care cost outcomes managed care expenditures managed behavioral health mental health
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.PubMedCrossRefGoogle Scholar
Grazier KL, Eselius LL. Mental health carve-outs: effects and implications. Med Care Res Rev. 1999;56(suppl 2):37–59.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
Druss BG, Rohrbaugh RM, Rosenheck RA. Depressive symptoms and health costs in older medical patients. Am J Psychiatry. 1999;156:477–9.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, U.S. Department of Health and Human Services; 1988.Google Scholar
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.Google Scholar
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
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.CrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
Koenig HG, Kuchibhatla M. Use of health services by hospitalized medically ill depressed elderly patients. Am J Psychiatry. 1998;155:871–7.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
Savoca E. Psychiatric co-morbidity and hospital utilization in the general medical sector. Psychol Med. 1999;29:457–64.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
Rost K, Smith R, Matthews DB, Guise B. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med. 1994;3:333–7.PubMedCrossRefGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12:34–43.PubMedCrossRefGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedGoogle Scholar
Khan AA, Khan A, Harezlak J, Tu W, Kroenke K. Somatic symptoms in primary care: etiology and outcome. Psychosomatics. 2003;44:471–8.PubMedCrossRefGoogle Scholar
Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med. 1993;153:2474–80.PubMedCrossRefGoogle Scholar
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.PubMedGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Scheffler RM. Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture. J Ment Health Policy Econ. 1999;2:21–8.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
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