Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 27, Issue 1, 2024. Pages: 33-39
Published Online: 1 March 2024

Copyright © 2024 ICMPE.

PERSPECTIVE
Health Economic Interests at NIMH and NIDA to Improve Delivery of Behavioral Health Services

Jennifer L. Humensky,¹ Sarah Q. Duffy,² Leonardo Cubillos,³ Michael C. Freed,⁴ Agnes Rupp⁵

¹PhD, Services Research and Clinical Epidemiology Branch, Division of Services and Intervention Research, National Institute of Mental Health,
National Institutes of Health, Rockville MD, USA.
²PhD, Services Research Branch, Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse,
National Institutes of Health, Rockville MD, USA.
³MD, MPH, Center for Global Mental Health Research, National Institute of Mental Health, National Institutes of Health, Rockville MD, USA.
⁴PhD, EMT, Services Research and Clinical Epidemiology Branch, Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Rockville MD, USA.
⁵PhD, Services Research and Clinical Epidemiology Branch (Retired), Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Rockville MD, USA.

Few studies have estimated the economic burden of chronic psychotic disorders using an incidence-based approach. This study estimated the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system (i.e., Ontario, Canada). Using a robust cost estimator, discounted cumulative mean health care costs were estimated from diagnosis to death or the end of observation period for the 1-, 5-, 10- and 15-periods: $24,420.08, 95% CI ($24,145.24-$24,694.92), $69,945.65, 95% CI ($69,018.79-$70,872.52), $115,142.91, 95% CI ($113,378.25-$116,907.57), and $153,332.13 ($151,121.74-$155,542.52), respectively. Cumulative costs were generally higher for males. Psychiatric hospitalisations made up the largest share of costs. Results suggest that costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation.

Background: Effective financing mechanisms are essential to ensuring that people can access and utilize effective treatments and services. Financing mechanisms are needed not only to pay for the delivery of those treatments and services, but also ancillary costs, while also keeping care affordable.

Aims: This article highlights key areas of the interest of the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) in supporting applied health economics and health care financing research. Specifically, this article discusses the long-range impact of NIH’s earlier investments in applied health economics research, and NIH’s ongoing efforts to communicate its interests in health economics research. We discuss the 2023 NIMH-NIDA-sponsored health economics conference, and the ideas presented there for developing and assessing innovative behavioral health care financing models; three of the presented papers were recently published in the Journal of Mental Health Policy and Economics.

Methods: We describe the history and impact of NIMH- and NIDA-sponsored economic research and identify current research interests as identified in the NIMH and NIDA Strategic Plans and recent funding announcements. We examine themes presented at the NIMH-NIDA Health Economics conference. The conference included over 300 participants from 20 countries, from six continents.

Results: The topics highlighted at the conference highlight the ways in which NIH-funded research has promoted the development of innovative health care financing methods, both from the supply side (e.g., providers and payers) and demand side (e.g., service users and families). Invited speakers discussed the findings from NIH-supported research in the topic areas of payment and financing, behavioral economics and social determinants of health. Keynote speakers highlighted emerging topics in the field, including the economics of health equity, biases in mental health models in health care, and value-based insurance design.

Discussion: We demonstrate a resurgence of and explicit interest in health economics and policy research at NIMH and NIDA. However, more work is needed in order to design funding mechanisms that fully provide access to and facilitate use of effective evidence-based practices to improve mental health outcomes. For example, it is important that policy and health economic research projects include decision makers who will be the end users of data and study results, to ensure that results can be meaningfully put into practice.

Implications for Health Care: Designing effective and efficient funding mechanisms can help ensure that service users have access to effective treatments and that clinicians and provider organizations are adequately compensated for their work.

Implications for Health Policies: Federal, state, and local policies, as well as policies of payers and health care organizations, can influence the type of care that is supported and incentivized.

Implications for Further Research: As demonstrated by the research interests as outlined in their respective Strategic Plans and funding announcements, NIMH and NIDA continue to fund health economic and policy research that aims to improve health care access, quality and outcomes for people with or at risk of developing behavioral health conditions in the US and around the world.