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The Enormous Cost of Mental Health Care

Priyam Vora
Patients with high mental health care costs incur nearly 30% more costs than the usual high-cost patients.
Patients with high mental health care costs incur nearly 30% more costs than the usual high-cost patients, according to a study in Health Affairs.

High-cost patients account for an overly large share of healthcare costs. They are primarily a small sub-group, but they are responsible for most of healthcare costs because of their high risk of hospitalization, expensive care, or the allocation of resources toward their care.

However, another subcategory deserves attention too—patients who use a substantial amount of mental health care services. A high-cost mental health patient is someone whose mental health care accounts for at least 50% of their total healthcare costs.

Claire de Oliveira, PhD, and colleagues used data from the Institute for Clinical Evaluative Sciences in Toronto, Ontario. The study group consisted of patients 18 years of age and older who had at least 1 encounter with the Ontario healthcare system in 2012.

For research purposes, the patients were divided into 2 groups: mental health high-cost patients and non-mental health high-cost patients. Mental health care costs included psychiatric hospitalizations, acute inpatient hospitalizations, emergency department visits, self-harm diagnosis, prescription drugs used to treat psychiatric disorders, and any psychiatrist-related billings.

Any other non-psychiatric costs were included in the non-mental health care costs. The study excluded children and adolescents, as well as addiction-related health care costs.

Out of the study population of 987,887 high-cost patients, it was found that 51,457 belonged to the mental health category. Mental health high-cost patients made up about 5% of all high-cost patients and accounted for roughly 7% of the costs for the entire high-cost patient population. The average cost of a mental health high-cost patient was $31,611 (Canadian dollars) vs. the average cost of a non–mental health high-cost patient of $23,681 (Canadian dollars).

The mental health high-cost population was 51% female and 49% male. Compared with non-mental health high-cost patients, most of them were younger, and lived in poorer neighborhoods. Another striking revelation was the median age for both high-cost groups. Mental health care costs were the highest for patients around 46 years of age, whereas non-mental health care costs peaked older than 80 years of age.

The health diagnosis showed mental health costs revolving around mood disorders and schizophrenia. The non-mental costs, on the other hand, were linked to more physical concerns of the circulatory and digestive systems.

The study facilitates in implementing policies or interventions to address quality of care for mental health patients. Better understanding of their complex background and profile such as age, qualities of their illnesses and their economic capacity helps healthcare providers in dispensing appropriate care in a cost-efficient manner.

Little research has been done on the costs related to mental health. If policies and interventions are designed specifically to treat the mental health high-cost patients, we can eventually help in bringing down the cost of care by preventive measures.

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