The United States is infamous for its healthcare spend. As noted in a 2016 Commonwealth Fund research report, the U.S. allocates a whopping 18% of the nation’s economy to healthcare—nearly double that seen in other first-world countries. Yet, despite such extravagant expenditures, the U.S. has poorer overall health outcomes to show for it.
Mental and substance abuse disorders account for a large chunk of America’s healthcare costs. Charles Roehrig, PhD, a fellow at the Altarum Institute, a nonprofit health systems research and consulting organization, says such disorders, which include depression, Alzheimer’s disease, and addiction, account for hundreds of billions of dollars in medical spending each year—outpacing the spend for heart attacks and cardiovascular disorders.
“These are very costly conditions that are accountable for a large percentage of hospitalizations across the country,” says Emily Ehrlich, deputy director at Altarum’s Center for Behavioral Health. “To help improve care and decrease costs, healthcare organizations should focus on finding ways to prevent and treat these complex conditions, improving the overall health of patients.”
Here are three of the most costly categories of mental health disorders:
- 1. Anxiety and depression. Roehrig’s research has found that anxiety and mood disorders are the most expensive condition category.
“We looked at purely the healthcare cost component of these disorders,” he says. “That includes what is being spent on hospital care, physician care, prescription drugs, and nursing home care. Anxiety and depression, as a category, topped our list.”
Tami Mark, a behavioral health economist at RTI International, a nonprofit research and development organization, says this may come as a surprise to some, as many patients can often be successfully—and relatively cheaply—treated with antidepressant medications and a few counseling appointments.
“These conditions aren’t that expensive to treat per patient,” she explains. “But there are so many people with these conditions that the costs do add up, especially when depression presents with other physical health conditions.”
2. Dementia and Alzheimer’s disease. With some analyses suggesting nearly 30 million Baby Boomers will develop Alzheimer’s disease before 2040, the costs associated with this neurodegenerative disorder, as well as other forms of dementia, are of great concern to healthcare economists.
“This becomes quite costly because of the nursing home costs,” says Roehrig. “Many patients will require long-term care and hospitalization, which can be a great financial burden to not only patients, but private insurance companies and government programs like Medicare and Medicaid.”
3. Substance abuse and addiction. Mark says it’s difficult to know the true costs of addiction since these conditions often present with other mental health issues and chronic substance abuse can lead to long-term—and expensive—physical health conditions.
“If you think about alcoholism, this is a disease, in its late stages, that impacts a lot of other aspects of a patient’s health,” she says. “It’s not just about the costs of treating alcoholism, but also the costs of overdoses, liver disease, cancer, and car accidents. These are costs that can really add up.”
Furthermore, it can take years for people to kick the habit, even with a doctor’s help.
“People tend to relapse and it can take time to get things under control,” she explains. “But that’s true of any chronic disease. It may take you a year or two to get your diabetes or asthma under control. Substance abuse is no different—and we see that, ultimately, many, many people are effectively treated.”
While mood disorders, dementia, and addition top the list of behavioral health spend, Mark cautions that most of these conditions don’t present by themselves.
“Very few people have just depression. It’s depression and a personality disorder. Or depression and substance abuse,” she says. “It’s important to understand that many of these categories are fairly artificial and it can change the way we slice and dice the costs associated with them.”
Ehrlich agrees—and adds that it’s also important to understand that mental health and physical health are strongly interlinked. Patients with dementia often have a host of other physical ailments. Studies of depression now show it is strongly associated with heart problems and metabolic disorders. And the mental health issues can make it more difficult to treat the physical ones, also increasing healthcare costs.
“Mental health conditions are very common and really do touch every aspect of healthcare,” she says. “One in five people are diagnosed with a mental health condition each year. That condition can greatly influence their physical health. That’s why it’s so important for healthcare organizations to look at the overall health of a patient, both behavioral and physical, to help manage costs and improve overall patient outcomes.”