Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 12, Issue 2, 2009. Pages: 87-95
Published Online: 20 June2009

Differences in Medical Care Expenditures for Adults with Depression Compared to Adults with Major Chronic Conditions

Ithai Z. Lurie¹*, Larry M. Manheim², Dorothy D. Dunlop³

¹Ph.D., Office of Tax Analysis, US Department of the Treasury, Washington DC, USA.
²Ph.D., Institute for Healthcare Studies, Department of Physical Medicine and Rehabilitation, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
³Ph.D., Institute for Healthcare Studies, Department of Medicine, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA.

* Correspondence to: Ithai Lurie, Ph.D. Office of Tax Analysis - US Department of Treasury - 1500 Pennsylvania Avenue NW - Washington DC 20220 - USA
Tel.: +1-202-622 1789
Fax: +1-202-622 8784
E-mail: ithai.lurie@do.treas.gov

Source of Funding: This study is supported funding from NIH/National Institute for Arthritis and Musculoskeletal Diseases P60-AR48098, and NIH/ National Center for Medical Rehabilitation Research R01-HD45412.
The views expressed are those of the authors and are not necessarily those of the U.S. Department of the Treasure.

Abstract

Approximately 8% of the U.S. adult population reported having a major depressive episode in 2004. This paper estimates, for the population under age 65, total and out-of-pocket medical expenditures for those with depression and compares these expenditures to those for non-depressed individuals who have another major chronic disease. Data identifying the population of interest are from the 1999 National Health Interview Survey. The linked 2000 Medical Expenditure Panel Survey provides their medical expenditures. Depression assessed using the CIDI-SF. To control for differences from potentially confounding factors, we matched depressed cases to controls using propensity score matching. We estimate that persons with depression have about the same out-of-pocket expenditures while having 11.8% less total medical expenditures (not statistically significant) compared to non-depressed individuals with at least one chronic disease. Given the lower income of those with depression, comparable out-of-pocket costs are likely to translate into a greater financial burden.

Background: Approximately 17.1 million adults report having a major depressive episode in 2004 which represents 8% of the adult population in the U.S. Of these, more than one-third did not seek treatment. In spite of the large and extensive literature on the cost of mental health, we know very little about the differences in out-of-pocket expenditures between adults with depression and adults with other major chronic disease and the sources of those expenditures.

Aims: For persons under age 65, compare total and out-of-pocket expenditures of those with depression to non-depressed individuals who have another major chronic disease.

Methods: This study uses two linked, nationally representative surveys, the 1999 National Health Interview Survey (NHIS) and the 2000 Medical Expenditure Panel Survey (MEPS), to identify the population of interest. Depression was systematically assessed using a short form of the World Health Organization's (WHO) Composite International Diagnostic Interview -- Short Form (CIDI-SF). To control for differences from potentially confounding factors, we matched depressed cases to controls using propensity score matching.

Results: We estimate that persons with depression have about the same out-of-pocket expenditures while having 11.8% less total medical expenditures (not a statistically significant difference) compared to non-depressed individuals with at least one chronic disease.

Discussion: High out-of-pocket expenditures are a concern for individuals with chronic diseases. Our study shows that those with depression have comparable out-of-pocket expenses to those with other chronic diseases, but given their lower income levels, this may result in a more substantial financial burden.

Implication for Policy: High out-of-pocket expenditures are a concern for individuals with depression and other chronic diseases. For both depressed individuals and non-depressed individuals with other chronic diseases, prescription drug expenditures contribute most to out-of-pocket expenses. Given the important role medications play in treatment of depression, high copayment rates are a concern for limiting compliance with appropriate treatment.

Received 6 July 2008; accepted 16 May 2009.