Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture

Scheffler, Richard M.

doi:10.1002/(sici)1099-176x(199903)2:1<21::aid-mhp33>3.0.co;2-o

Cited by 15 publications

(7 citation statements)

References 18 publications

(15 reference statements)

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“…Wechsler (1961) showed that depression and suicide were more frequent in communities that had rapidly grown, and increased population may imply changes that may Costa-Font and Gil (2006) found a significant impact of socio-economic inequality on reported depression in Spain, corroborating findings elsewhere (La Gory and Fitzpatrick, 1992;Lorant et al, 2003;Muramatsu, 2003;Scheffler, Zhang and Snowden, 2001;Scheffler, 1999 andZimmerman andKaton, 2005). Wilkinson (1997) argues that stress caused by the perception of income inequality leads to depression and poorer health.…”

Section: Are Countries' Characteristics Relevant Stressors?mentioning

confidence: 60%

A Cross-Country Analysis of the Risk Factors for Depression at the Micro and Macro Level

Melgar

Rossi²

2010

SSRN Journal

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may Abstract *Past research has provided evidence of the role of some personal characteristics as risk factors for depression. However, few studies have examined jointly their specific impact and whether country characteristics change the probability of being depressed. In general, this is due to the use of single-country databases. The aim of this paper is to extend previous findings by employing a much larger dataset and including the country effects mentioned above. The paper estimates probit models with country effects and explores linkages between specific environmental factors and depression using data from the 2007 Gallup Public Opinion Poll. Findings indicate that depression is positively related to being a woman, adulthood, divorce, widowhood, unemployment and low income. Moreover, there is evidence of the significant positive association between inequality and depression, especially for those living in urban areas. Finally, some population's characteristics facilitate depression (age distribution and religious affiliation). IntroductionDepression is one of the world's most widespread mental illnesses and one that affects people for a wide variety of reasons. The relevance of investigating the factors that facilitate depression is twofold. On one hand, it has a strong impact on quality of life and happiness.On the other hand, this knowledge may be useful for identifying at-risk groups and for health policy design.As the Centre for Economic Performance (2006) however, have focused on only one dimension or used single-country surveys. In other words, they did not consider all individual characteristics at the same time, or they were unable to include background effects.As well-being is directly related to depression and unhappiness, depression should become a policy issue. As Layard (2008) pointed out, what matters is to find the conditions in which (un)happiness occurs in order to undertake active policies. Hence, the aim of this paper is to determine the factors that increase the probability of being depressed at both the micro and macro levels.The main contributions of this study are threefold. First, by employing a large dataset, we are able to extend previous findings and to compute simultaneously the effects of specific individuals' characteristics on the probability of being depressed. Second, we assess how individuals are affected by background-in particular, whether countries' attributes are significa...

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Section: Are Countries' Characteristics Relevant Stressors?mentioning

confidence: 60%

A Cross-Country Analysis of the Risk Factors for Depression at the Micro and Macro Level

Melgar

Rossi²

2010

SSRN Journal

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“…The impact of these plans on the costs of insurance has been measured (Goldman et al 1998;Ma and McGuire 1998). Such plans have enjoyed an increasing market share (Scheffler 1999).…”

Section: Impact On Efficient and Equitable Utilization Of Mental Healmentioning

confidence: 99%

Financing mental health services in low- and middle-income countries

Dixon¹,

McDaid²,

Knapp³

et al. 2006

Health Policy and Planning

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Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

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“…Yet another explanation for the results found in this retrospective cost trend analysis is that the magnitude and persistence of the interaction have nothing at all to do with the medical and psychiatric illnesses. Rather, the interaction may be the product of a medical system in which disincentives to use behavioral health care introduced by managed behavioral health business practices, 42–44 difficulty in accessing behavioral health services, 45 loss of behavioral health coverage, 46 and/or exhausting annual or lifetime behavioral health benefits drives patients from the behavioral health sector to the medical sector for assistance as they attempt to alleviate psychiatric suffering which has not been successfully treated. Evidence for “cost shifting,” as described here, can be found in a study by Rosenheck et al 25 who demonstrated that, while the introduction of managed behavioral health practices reduced behavioral health service costs by 37.7% in 21,000 employees of a large manufacturing corporation over 3 years, there was an associated 36.6% increase in nonbehavioral health expenses with a net annual increase in total health care costs of $130/enrollee.…”

Section: Discussionmentioning

confidence: 99%

General medical and pharmacy claims expenditures in users of behavioral health services

et al. 2005

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OBJECTIVE:To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications. MAIN RESULTS:Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. CONCLUSIONS:The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/ or administrative approaches that reverse the high use of general medical resources in behavioral health patients. T he evaluation and treatment of mental disorders causing emotional or behavioral difficulties and/or chemical dependence, collectively known as behavioral health disorders, have been effectively separated from the evaluation and treatment of general medical disorders. Most of those with health care coverage for behavioral health needs are served by managed behavioral health organizations.1,2 These management companies operate autonomously either from the managed medical care organization administering general medical benefits to the same patients (a behavioral health carve-out) or from the parent managed care organization which owns the behavioral health business (a behavioral health carve-in) but still manages behavioral health work processes (networks, care management, claims, etc.) separately. In practice, there is little difference between the two in the way that they service behavioral health needs. As a result of the widespread administrative separation of these two areas of health care, few studies have focused on the interaction of general medical, pharmacy, and behavioral health service use in those receiving behavioral health treatment. This article expands on our current understanding of the magnitude, persistence, and interaction of behavioral h...

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Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture

Cited by 15 publications

References 18 publications

A Cross-Country Analysis of the Risk Factors for Depression at the Micro and Macro Level

A Cross-Country Analysis of the Risk Factors for Depression at the Micro and Macro Level

Financing mental health services in low- and middle-income countries

General medical and pharmacy claims expenditures in users of behavioral health services

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