Psychiatric symptoms, impaired function, and medical care costs in an HMO setting
Introduction
The primary goal of mental health care is to relieve the suffering and disability of patients who have clinically significant psychiatric distress. Accumulating evidence suggests that depressive symptoms and disorders are commonly associated with increased use of medical services [1], [2], [3], [4], [5]. In 1 HMO, for example, depressive symptoms increased overall health care costs for elderly patients by approximately 50% [1]. Health care costs rose with an increasing number of depressive symptoms. Adults with a diagnosis of depression from the same HMO were also found to have higher medical care costs than ostensibly similar nondepressed adults [2]. In an inner city ambulatory care clinic [3], [4] and a fee-for-service private health plan [5], depression has also been linked to increased health care costs.
Less is known about the general health care cost consequences of anxiety and anxiety disorders. Some evidence indicates that panic disorder [6], [7] and health-related anxiety [6] are associated with increased health care costs. However, little is known about the extent to which more common forms of excessive and persistent anxiety are related to elevations in overall medical care utilization and costs or specific types of utilization, such as inappropriate emergency room visits.
The current study examines relationships among anxiety, depression, and associated impaired role function with the costs of general medical services. We assess the effect of symptoms and impairment on specific types of general medical care utilization within a large HMO with an integrated care delivery system. We hypothesize that as the number of psychiatric symptoms and associated role dysfunction increases, use and cost of nonpsychiatric health care (general medical care) increases.
Section snippets
Data
Data were obtained from a telephone survey of a random sample of the adult health plan members of the Kaiser Permanente Medical Care Program in Northern California and 5 administrative and clinical databases maintained by Kaiser: 1) Cost Management Information System, a cost accounting software package that allocates costs by department, medical center, patient, or medical service; 2) Outpatient Summary Clinical Record, which captures, for each clinic visit, the department, type of provider,
Results
Approximately one quarter (24%) of the continuously enrolled adult plan members reported having 1 or more of the 5 psychiatric symptoms (Table 1). Of those reporting symptoms, about one half reported having a single symptom. The most prevalent symptom was brief anxiety (17%), followed by trouble controlling violent behavior (8.5%), depressed mood (7.5%), persistent anxiety (5.9%), and panic attacks (4.9%). The psychiatric symptoms affected the work, family, or social functioning of 4.5% of all
Discussion
Persistent anxiety and depressed mood are strong predictors of general medical care service utilization and costs. When these symptoms become so severe that they reduce work, family, or social functioning, additional medical care costs are incurred. The effects tend to be additive, so that patients with depressed mood, persistent anxiety, and widespread impairment have roughly twice the medical care costs of patients without these symptoms or impairments. Panic attacks, brief anxiety, and
Acknowledgements
We are indebted to Clara Haliburton, Yolanda Yarbough, and Ras I. Cush for preparation of this manuscript. We thank Kaliya Okuri and David Cherry for editorial assistance and Francois Collin for assistance with data analysis. We thank Irene Fraser, Mark Olfson, Fred Hellinger, Sam Zuvekas, Claudia Steiner, A. Thomas McLellan, Thomas Croghan, William Berman, William Hargreaves, and Joe Selby for reviewing this manuscript and providing insightful comments.
This research was a collaboration between
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