Abstract
The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown. To determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions. This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilization among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and posttraumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019. Diagnosis of an SMI or other common mental health disorder. Risk-adjusted, standardized spending and health care utilization. Multivariable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical comorbidities, using hospital referral region fixed effects. Of 4 358 975 Medicare beneficiaries, 987 379 (22.7%) had an SMI, 326 991 (7.5%) had another common mental health disorder, and 3 044 587 (69.8%) had no known mental illness. Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001). Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001). Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders. Among Medicare beneficiaries, $2 686 016 110 of $64 326 262 104 total Medicare spending (4.2%) went to mental health services and an additional $5 482 791 747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders. In this study, having a mental health disorder was associated with spending substantially more on other medical conditions. These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.
Highlights
Mental health disorders are highly prevalent among the US population
Among Medicare beneficiaries, $2 686 016 110 of $64 326 262 104 total Medicare spending (4.2%) went to mental health services and an additional $5 482 791 747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders
Abbreviation: COPD, chronic obstructive pulmonary disease. a All differences across gender, race/ethnicity, dual status, region, locality, and major comorbidities were statistically significant (P < .001). b Other common mental health disorders included anxiety disorders, personality disorders, and posttraumatic stress disorder. c Serious mental illness was defined as having schizophrenia or related psychotic disorders, bipolar disorder, or major depression. d The variable in the Medicare data describes other as Asian, Native American, and other
Summary
Mental health disorders are highly prevalent among the US population. In 2017, it was estimated that about 44.7 million adults, or nearly 1 in 5, have a mental health disorder, and about a quarter of those (ie, 10.4 million adults) have a serious mental illness (SMI), such as schizophrenia or bipolar disorder.[1]. Mental illness has been associated with a variety of disease risk factors, such as obesity, low physical activity, and smoking.[3,4,5,6] In addition, the presence of a mental illness can profoundly affect the ability of patients and health systems to manage other chronic medical conditions.[7] In turn, increased risk for and poor management of chronic conditions could lead to worse health outcomes and greater use of health care services, from additional emergency department visits to hospitalizations and, with worsening progression of underlying medical conditions, more expensive interventions.[8,9] As a result, the true financial cost of mental health disorders may be reflected in additional treatments for non–mental health conditions While this notion is widely discussed, we are unaware of any empirical data that has, on a national scale, given an exact account of the association of mental health disorders with additional spending on medical conditions after accounting for underlying risk differences in patients with and without mental illness among the Medicare fee-for-service population. To fully understand the financial consequences of mental health disorders, it would be helpful to understand the amount of spending directly associated with mental illness and the amount of spending on other conditions indirectly associated with mental illness.[10]
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