Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, and Sutter Health Center for Health Systems Research, Berkeley (Bui); Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Yoon); Health Management and Policy, College of Public Health and Human Sciences, and Health Data and Informatics, Center for Genome Research and Biocomputing, Oregon State University, Corvallis, and Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs Portland Healthcare System, Portland (Hynes).
Psychiatr Serv. 2021 Jul 1;72(7):766-775. doi: 10.1176/appi.ps.202000161. Epub 2021 May 4.
The aim was to examine the impact of receipt of mental health services on health care expenditures for U.S. adults with major chronic physical conditions.
Medical Expenditure Panel Survey data for 2004-2014 were analyzed for adults ages ≥18 with at least one of six chronic physical conditions (cardiovascular diseases, cancer, diabetes, emphysema, asthma, and arthritis) who were followed up for 2 years (N=33,419). Outcomes included overall health care spending and expenditure by service type (inpatient services, outpatient services, emergency department visits, office-based physician visits, and prescribed medication). A difference-in-differences model compared a change in health care costs in the subsequent year for those who did and did not receive mental health services in the preceding year.
On average, the increase in overall health care expenditure in the subsequent year among adults receiving mental health services in the preceding year was smaller by 12.6 percentage points (p<0.05) than for those who did not receive such services. The difference was equivalent to $1,146 in 2014 constant U.S. dollars (p=0.05). Medication treatment alone did not have a meaningful effect on overall costs. The combination of psychotherapy and medication was associated with a per-capita reduction in overall health care expenditure of 21.7 percentage points, or $2,690 (p<0.01). The combination was also associated with reduced costs for office-based visits (p<0.05) and medication (p<0.05).
Receipt of mental health services was associated with a reduction in overall health care costs, particularly for office-based visits and prescribed medication, among adults with chronic physical conditions.
本研究旨在探讨美国患有主要慢性躯体疾病的成年人获得精神卫生服务对其医疗支出的影响。
本研究分析了 2004-2014 年医疗支出面板调查数据，纳入至少患有六种慢性躯体疾病之一（心血管疾病、癌症、糖尿病、肺气肿、哮喘和关节炎）且随访时间≥2 年的成年人（n=33419）。结局包括总体医疗支出以及按服务类型（住院服务、门诊服务、急诊就诊、门诊医生就诊和处方药物）划分的支出。采用双重差分模型比较了在先前一年接受和未接受精神卫生服务的患者在随后一年医疗成本的变化。
平均而言，与未接受精神卫生服务的患者相比，在先前一年接受精神卫生服务的患者在随后一年的总体医疗支出增加幅度小 12.6 个百分点（p<0.05）。在 2014 年不变的美国美元中，这相当于 1146 美元（p=0.05）。仅药物治疗对总体成本没有显著影响。心理治疗联合药物治疗与人均总体医疗支出降低 21.7 个百分点（p<0.01），即 2690 美元相关。心理治疗联合药物治疗还与门诊就诊（p<0.05）和药物（p<0.05）费用降低相关。
患有慢性躯体疾病的成年人获得精神卫生服务与总体医疗支出的降低相关，尤其是与门诊就诊和处方药物相关的支出降低。
