Mental Disorders the Most Costly Illnesses

Fran Lowry

May 31, 2016

Mental disorders cost more than $200 billion a year in the United States, topping the list of the most costly conditions, according to an estimate of annual health spending for a variety of common medical conditions.

The amount spent for treating mental illness exceeds that spent for treating heart disease, stroke, and even cancer in this analysis of data from several datasets, including the National Health Expenditure Accounts and the Medical Expenditure Panel Survey.

The report, written by Charles Roehrig, PhD, founding director of the Center for Sustainable Health Spending at Altarum Institute, Ann Arbor, Michigan, was published online May 18 in Health Affairs.

It updates a report published in 2009 that covered the period 1996 to 2005 and uses similar data and methods, Dr Roehrig told Medscape Medical News.

"In 1996, when we first looked at medical spending over time, we found that spending on heart conditions was far and away the largest expenditure and mental disorders were a distant second," he said.

"Not only is spending on mental disorders way ahead of heart conditions, the spending is growing unusually fast. We are getting better at preventing heart disease and stroke, but spending on anxiety and depression has grown very rapidly within the mental disorders area," Dr Roehrig said.

The investigators included the cost of treating institutionalized individuals, which is something that previous surveys of health spending had not done.

"The inclusion of institutionalized populations has a significant impact on total spending. This is what has brought mental disorders to the top of the list of medical conditions with the highest estimated spending, at $201 billion in 2013," said Dr Roehrig.

More than 40% of this sum is spent on people who are in nursing homes and other institutions.

"Most big surveys don't survey people who are in nursing homes and long-term psychiatric care. Similarly for prisoners and active duty military personnel. We had to go through each type of medical service and estimate how much of the spending was attributable to the different population groups," he said.

Everyone bears the brunt of the increased cost of treating mental disorders, Dr Roehrig said.

"For Alzheimer's and dementia, a lot of the cost is nursing home spending and Medicaid, but a lot of that is people spending their own money," he said.

Keeping track of health spending is important, Dr Roehrig added.

"When all we talk about when we discuss how much we spend on hospital care, physician care, and prescription drugs, we start thinking about how to cut the cost. But as soon as you say we spend a ton of it on mental disorders, or diabetes, or whatever, suddenly the public health community can participate in the discussion. It opens it up to a much broader range of participants," he said.

The following are the top ten medical conditions for estimated spending in 2013:

  1. Mental disorders

  2. Heart conditions

  3. Trauma

  4. Cancer

  5. Pulmonary conditions

  6. Osteoarthritis

  7. Normal birth

  8. Diabetes

  9. Kidney disease

  10. Hypertension

The study was funded by the Bureau of Economic Analysis, Department of Commerce. Dr Roehrig reports no relevant financial relationships.

Health Aff. Published online May 18, 2016. Abstract

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