Psychiatr News December 7, 2007
Volume 42, Number 23, page 12
© 2007 American Psychiatric Association
Chronic Illness Cost to Soar Without Lifestyle Changes
Rich Daly
More than 30 million Americans are treated for mental illness annually.
To reduce that figure, the nation needs to invest in prevention and early
intervention efforts.
Each year mental illness costs Americans $216 billion, or 16 percent of the
more than the $1 trillion cost of the seven most common chronic health
conditions, in terms of treatment and lost productivity.
This was a startling finding of a recent study conducted by the Milken
Institute, a California economic think tank. The researchers found that 30.3
million Americans were receiving outpatient care for a mental illness in 2003,
the last year for which the statistics were available. The study, which was
based on 2003 data from the Census Bureau and the Agency for Healthcare
Research and Quality, did not count people in institutional care, such as
those in prison or nursing homes, for any health conditions.
The study determined that the economic impact of the seven most common
chronic illnesses, which are mental illness, cancer, hypertension, heart
disease, pulmonary conditions, diabetes, and stroke, goes far beyond the
expense of treating disease. It found the cost of treatment of the conditions
accounted for only 21 percent of their total costs; the remainder was due to
lost productivity. Lost productivity was in the form of extra sick days,
reduced performance by ill workers, and other losses not directly related to
medical care, according to the study.
The study authors concluded that life-style changes, disease prevention,
and early detection of disease could reduced the number of illnesses by 40
million cases and save $1.6 trillion from 2003 to 2023.
Lifestyle changes are needed, the authors said, because the number of all
chronic health conditions is growing, including the number of cases of mental
illness. Although the population is expected to grow by only 19 percent
between 2003 and 2023, the study authors estimated that the number of cases of
mental illness will increase by 54 percent.
The biggest cuts in the growth of chronic health conditions would come from
reducing obesity and smoking, although significant mental illness prevention
also is possible, according to the authors.
If the country does nothing to address these problems, the number of cases
diagnosed in the seven illness categories will increase by 42 percent by 2023,
for a total economic impact of $4.2 trillion, the report said.
"The disease burden is mounting, the economic burden is mounting, and
the trajectory we're on is unsustainable," said Richard Carmona, M.D., a
former U.S. surgeon general and now chair of the Partnership to Fight Chronic
Disease, at a September news conference in Washington, D.C.
The study authors noted that the reduction in future chronic illness is
unlikely to come from the tiny amount of current U.S. health care spending on
discouraging unhealthy behaviors that contribute to those conditions, such as
abusing alcohol and drugs, in the case of mental illness.
"The current health care debate rightly focuses on the extension of
coverage to the uninsured and the design of a financing mechanism that is both
fair and efficient," said the study authors. "We suggest that the
nature of services provided—the failure to invest in prevention and
early intervention—deserves equal place in the debate."
They estimated that such steps could reduce the annual number of new cases
of mental illness from 46,673 in 2003 to 40,910 in 2023. Such measures to
prevent mental illness could cut $28 billion in annual treatment costs and $88
billion in annual related economic costs by 2023.
The mental health cost savings could come, in part, through measures that
would reduce alcohol abuse, which affected 5.8 percent of the population in
2003. Their optimistic projection would reduce that to 4.2 percent of the
population by 2023.
The projected reduction in mental health conditions also could stem from a
gradual decline in illicit drug use. The authors calculated that educational
efforts to increase awareness about the risks of illicit drug use would cause
such use to plateau in the share of the total population affected. They
projected that after 2010 illicit drug use would begin a downward
trajectory.
The projections also assumed "a very slight acceleration" in
the availability and use of new treatments for mental disorders and other
conditions. Health care costs also are expected to drop for all conditions due
to a host of changes that improve the efficiency of care for chronic
conditions and increase coordination of this care. Additionally, they expect
more widespread treatment that adheres to accepted guidelines, efforts to
improve patient adherence to prescribed therapies, and faster adoption of
health information technology.
"While these assumptions are optimistic, they are not beyond our
reach. They address the most frequently cited behavioral risk factors and our
own calculations of the statistical relationships between the risk factors and
each condition," said the study authors.
The Milken Institute is part of a coalition of 87 medical groups,
businesses, and pharmaceutical companies that recently pushed for detection
and prevention efforts to receive more attention in the national health care
debate. The study was funded in part by a grant from the Pharmaceutical
Research and Manufacturers of America.
"An Unhealthy America: The Economic Burden of Chronic
Disease" is posted at
<www.milkeninstitute.org/pdf/ES_ResearchFindings.pdf>.
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