Shortsighted Cuts in Mental-Health Care

By Bardgett, Mark E. | St Louis Post-Dispatch (MO), July 17, 1995 | Go to article overview

Shortsighted Cuts in Mental-Health Care


Bardgett, Mark E., St Louis Post-Dispatch (MO)


What single medical disorder fills 40 percent of the hospital beds in this country and accounts for 2.5 percent of U.S. health expenditures? Schizophrenia.

This chronic mental illness, which afflicts 2 million to 3 million Americans, is characterized by debilitating hallucinations, delusions, inappropriate emotional responses and thought processes marked by incoherence. Unfortunately, current health-care policy toward schizophrenia is marked by a similar incoherence. While escalating health-care costs and a growing federal debt have demanded tighter fiscal management at government and corporate levels, unenlightened cost containment and budget-cutting measures only perpetuate the high economic and human costs of schizophrenia.

For example, as of last fall, 1nine states had implemented a cost-containment strategy that limited the number of per-month prescriptions paid by Medicaid. A later study in the New England Journal of Medicine reported that, while these limits had the intended effect of decreasing antipsychotic drug use by people with schizophrenia, they increased the number of their visits to mental health centers and emergency rooms. It was estimated that for every dollar this policy saved, it generated an additional $17 in health costs.

Not only are policies that indiscriminately limit prescriptions more costly, but a similar bottom line results from frugal insurance practices that insist on the most inexpensive prescriptions for people with schizophrenia. Newer anti-psychotic drugs have been developed that treat people who do not respond to traditional drugs. However, the costs of these newer drugs (up to $3,000 a year) make them less palatable to insurers.

What insurers and health-care policymakers must realize is that these drugs, despite their cost, ultimately save money by reducing hospitalization costs. Researchers at Case Western Reserve University found that if patients were allowed access to newer antipsychotic drugs, their total health-care costs were reduced by as much as $23,000 a year.

Reductions in the federal funding of research, necessitated by balanced-budget proposals, may also serve to increase long-term health-care costs in the name of short-term gains. Just as we stand ready to capitalize on recent research advances, Congress stands ready to cut funding for the National Institutes of Health, National Science Foundation and the Veterans Administration by as much as 10 percent ($1.5 billion) during fiscal 1996. These institutions account for a majority of not-for-profit research support in America and are responsible for dramatic advances in schizophrenia research.

These gains have been especially evident in the area of brain research. Advances in neurochemistry and neuroimaging have allowed researchers to pinpoint alterations in brain activity and structure that are associated with schizophrenia.

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