The findings represent a shift in spending from 1996, when annual spending on heart conditions was $105 billion compared with $79 billion for mental disorders.
For years the Agency for Healthcare Research and Quality (AHRQ) has produced estimates of spending by medical condition from its Medical Expenditure Panel Survey (MEPS), but these estimates are limited to the civilian non-institutionalized population. In contrast, Charles Roehrig, Ph.D., the founding director of the Center for Sustainable Health Spending at Altarum Institute in Michigan, pooled data from both civilian non-institutionalized and institutionalized (nursing community residents, psychiatric hospital inpatients, prisoners) and active-duty military to determine health spending estimates.
Roehrig found that mental disorders topped the list of health conditions by spending by a substantial margin, at $201 billion—of which more than 40 percent was spending for institutionalized populations.
“The fact that more than 40 percent is spent on populations in prisons, nursing homes, and other institutional settings demonstrates the need to invest more in preventive care,” APA President Maria Oquendo, M.D., told Psychiatric News. “Insurers should be compelled to follow the law and cover mental illness in the same manner as they cover physical illness. Removing currently existing, though illegal, barriers to access to mental health care can mean treating people earlier and avoiding costlier care later.”
Roehrig did note that the increases in health care spending seen for mental disorders were not due to a rapid rise in costs over the past two decades; since 1996, mental health spending has risen about 5.6% each year, which is right around the average rate for all diseases. Rather, costs for cardiovascular disease have been low, rising approximately 2% each year (suggested to be attributable to factors such as improved smoking habits and lower drug costs with the advent of generic statins).
“A look ahead suggests that reductions in deaths from heart conditions and cerebrovascular disease are likely to drive spending on mental disorders even higher, as more people survive to older ages—when mental disorders, such as dementia, become more prevalent,” Roehrig wrote.
Oquendo added, “While non-institutional mental health care is significantly less expensive, this study should be not misread to mean we need to invest less in mental health care. The reality is that we need to spend wisely.”
For related information, see the Psychiatric News article “The Critical and Evolving Roles for Psychiatry in Health Reform.”