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 Depression and Health Care: The High Cost of Saving 
The following is one in an ongoing series of columns entitled Mind Body Health by . View all columns in series
In spite of a growing body of research over the last decade documenting the economic burden of depression on individuals and on society, efforts to curb skyrocketing medical costs usually start with cuts in mental health services and benefits. Insurance coverage of mental health treatment in recent years has become more and more restrictive. Most health care reform proposals impose stricter limits on mental health care than on general medical services.

One recent study - the first to look beyond the direct cost of treating depression to the use of medical services in general - suggests that in the long run these cuts may be costing the health-care system far more than they save.

Examining accounting records of some 12,000 HMO patients of Group Health Cooperative of Puget Sound, researchers found annual medical costs for patients with diagnosed depression to be double those of patients not diagnosed with depression. The twofold difference persisted for at least 12 months after the patients began receiving treatment for depression.

The estimated price tag for this increased medical service utilization was a whopping $8.9 million over 1 year - compared to just $3.8 million spent on this group for mental health care services. Even among patients treated with antidepressant drugs, costs of these prescriptions accounted for less than half the difference in pharmacy costs.

Significant cost increases were identified in every category of care including primary care, medical specialty, medical inpatient, pharmacy and laboratory. Researchers also looked at how chronic disease might bias their findings, assuming that chronically ill patients could be expected to have higher medical costs and a greater likelihood of depression. Even after adjusting for chronic conditions, costs for the depressed group were typically 1.5 times those of the comparison group.

Researchers also point out that since only patients with recognized depression were included in the test group, and since depression often goes undiagnosed and untreated, the real cost differences may be far greater than even their data indicate. Unfortunately, the increase in costs in the depressed patients occurred despite recognition and initiation of treatment of depression. This means that we still need to improve the management of the complex problems and learned pattern of frequent medical visits of depressed patients if overall costs are to be decreased.

Clearly, depression must be taken as seriously as any other chronic medical disease for impact on overall medical costs - and, of course, for the suffering, disability, work loss and impaired quality of life this disease brings in its wake.

All of us must be concerned about the rising cost of health care. These figures suggest that increasing and improving treatment of depression - not cutting services - is the right thing to do.

For More Information
Simon GE, VonKorff M, Barlow W: Health Care costs of primary care patients with recognized depression. 0 1995;52:850-856.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

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 About The Author
David S. Sobel, M.D., M.P.H., is a practicing physician in adult medicine and Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California. He is physician lead for the......moreDavid Sobel MD
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