Trends in mental health cost growth: An expanded role for management?

Health Affairs

Volumn 28, Issue 3, 2009, Pages 649-659

  Frank, Richard G ^a   Goldman, Howard H ^b   McGuire, Thomas G ^a  

^a HARVARD MEDICAL SCHOOL   (United States)

^b UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; FINANCIAL MANAGEMENT; HEALTH CARE; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH INSURANCE; HUMAN; MENTAL HEALTH CARE; MENTAL HEALTH SERVICE; PATIENT CARE;

COST-BENEFIT ANALYSIS; DRUG COSTS; FORECASTING; HEALTH CARE COSTS; HEALTH EXPENDITURES; HEALTH POLICY; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE, PSYCHIATRIC; MANAGED CARE PROGRAMS; MEDICAID; MEDICARE; MENTAL DISORDERS; MENTAL HEALTH SERVICES; PSYCHOTROPIC DRUGS; UNITED STATES;

EID: 66749185907     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.3.649     Document Type: Article

References (42)

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3. Centers for Medicare and Medicaid Services, "NHE Projections 2008-2018," http://www.cms.hhs.gov/NationalHealthExpendData/03- NationalHealthAccountsProjected.asp (accessed 16 March 2009).
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24. We used two of MEPS data sets. The first is the Full-Year Consolidated Data Set, which includes information on individual demographics, health insurance status in all twelve months, self-reported health and mental health status in each round of collection, spending for the year, and the source(s) of payment for that spending. In a companion file, the second data set includes the same individuals but breaks spending down further into spending per health event (as defined by a provider/observation interaction), allowing for the separation of a year's spending into its component parts. These events include hospital inpatient stays, hospital outpatient visits, emergency room care, prescriptions, and office-based visits.
25. Details of our data selection and variable definitions are available in an appendix, online at http://content.healthaffairs.org/cgi/content/full/28/3/ 649/DC1.
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27. Health accounts rely more on supply-side rather than demand-side data. In general, provider reports tend to be more complete, except for the category of out-of-pocket spending.
28. It is important to note that psychotropic drugs have been affected by patent expirations and entry by generics, as has the market for prescription drugs generally. However, antidepressants began to lose patent protection in 2001, which was on the early side of the wave of patent expiration. Antipsychotics remain largely on patent, with the exception of Risperidone. On balance, psychotropic drugs reflect overall industry patterns of patent loss.
29. See Appendix Exhibit 1 in the online appendix, as in Note 24.
30. Levit et al., "Future Funding for Mental Health and Substance Abuse."
31. Regression results are available in the online appendix, as in Note 24.
32. The Medicare-specific graph appears as Appendix Exhibit 2 in the online appendix; ibid.
33. The inpatient spending estimates should be interpreted cautiously, because MEPS tends to underreport inpatient psychiatric use and spending. Graphs showing payers by service are available as Appendix Exhibits 2-5 in the online appendix; ibid.
34. These drugs have also dramatically changed the effectiveness of treating anxiety disorders.
35. It is worth noting that the period after 2001 was one in which a number of new antidepressants lost patent protection and faced intense price competition, resulting in lower costs per prescription. Nevertheless, a number of new atypical antipsychotic drugs were launched, and few have lost patent protection.
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