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Treatment Perspectives: Cost and Quality. Alexander S. Young, M.D., M.S.H.S. VA VISN 22 Mental Illness, Research, Education, and Clinical Center (MIRECC) UCLA Research Center on Managed Care for Psychiatric Disorders. Healthcare in the U.S.: Cost. Treatment costs - PowerPoint PPT Presentation
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Treatment Perspectives:
Cost and Quality
Alexander S. Young, M.D., M.S.H.S.
VA VISN 22 Mental Illness, Research, Education, and Clinical Center (MIRECC)
UCLA Research Center on Managed Care for Psychiatric Disorders
Healthcare in the U.S.:Cost
Treatment costs– 14% of GNP (up from 7% in 1970)
» highest per-capita spending in the world
– $1,000,000,000,000 per year» half of corporate pre-tax profits
– 2.5% for treatment of schizophrenia
Healthcare in the U.S.:Quality
Health status outcomes (of 13 nations)– infant mortality: 13th
– life expectancy: 10th at 40 years, 7th at 65 years
– overall: 12th
Potential explanations– many with no insurance (> 40 million)
– expensive treatments with minimal effectiveness
Depression & Anxiety
Major Depression, Dysthymia Generalized Anxiety Disorder, Panic
Disorder Effective Treatments
– medications: antidepressant and antianxiety
– psychotherapy
Depression & Anxiety: Two Thirds Receive No Effective Care
Depressive or Anxiety Disorder (n=1641) %
Effective medication 21
Effective counseling 18
Either effective antidepressant or effective counseling 31
RACE AGE
% with no effective medication or counseling
63%
81%76% 79%
69%62%62%
67%
White Black Hispanic 20 30 40 50 60 70
76%
Older, Younger, and Minorities Receive Worse Care
Schizophrenia
Effective Treatments– antipsychotic medications
– PACT
– family/caregiver involvement
– vocational rehabilitation
Stigma and disadvantage
Schizophrenia: Quality Problems Are Severe and Differ By
Organization
Medication Management
Severe symptoms or side effects
Poor quality medication management
CMHC VA
43%
31%
55%
44%
SPMI: Key Quality Problems 50 – 70% receive no treatment
– incarceration
Mortality and morbidity Treatment organizations
– substantial cost
– consumers with little power over service provision
– medication management: > 1/3 with poor care
– family/caregiver involvement, PACT, vocational rehabilitation: usually not provided
Methods for Improving Care Improve policy
– how can we change policy so that it supports effective, efficient care for serious mental illness?
Managed care Reduce system fragmentation
– RWJF experiment
Monitor performance– NCQA: HEDIS
– VA: report card
Methods for Improving Care (cont.)
Improve clinicians’ competencies Implement disease management
– change division of labor and responsibilities
– increase focus on clients’ needs
Really empower consumers– self-help and peer support
– recovery model
Panel Steve Segal, Ph.D.
– School of Social Welfare, UC Berkeley
Barbara Havassy, Ph.D.– Department of Psychiatry, UCSF
Judge Harold E. Shabo– Los Angeles Superior Court
Dave Hosseini– Sacramento Consumer Self-Help Centers and
Office of Patients' Rights
References
– Starfield B: Is US health really the best in the world? JAMA. 2000; 284: 483-5.
– Young AS, Sullivan G, Burnam MA, Brook RH: Measuring the quality of outpatient treatment for schizophrenia. Archives of General Psychiatry. 1998; 55: 611-7.
– Young AS, Forquer SL, Tran A, Starzynski M, Shatkin J: Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness. Journal of Behavioral Health Services & Research. 2000; 27: 321-333.
– Young AS, Klap R, Sherbourne CD, Wells KB: The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry. 2001; 58: 55-61.
For further information
– Alexander S. Young, MD, MSHS
– VISN 22 MIRECC, West Los Angeles Veterans Healthcare Center & UCLA, 11301 Wilshire Blvd. (210A), Los Angeles CA 90073; phone: (310) 478-3711 x42460