Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 9, Issue 3, 2006. Pages: 133-136

Published Online: 12 September 2006

Trends in the Professional Mix and Cost of Outpatient Mental Health Care

Greg A. Greenberg*¹ and Robert A. Rosenheck²

¹Ph.D., Project Director, Northeast Program Evaluation Center, VAMC West Haven, CT; Lecturer, Yale University Department of Psychiatry, New Haven, CT, USA
²M.D., Director, Northeast Program Evaluation Center, VAMC West Haven, Ct., VA New England Mental Illness Research, Education, and Clinical Center; Professor, Department of Psychiatry and Yale University School of Epidemiology and Public Health, New Haven, CT, USA

* Correspondence to: Greg A. Greenberg, Northeast Program Evaluation Center 950 Campbell Ave, West Haven CT 06516, USA
Tel.: +1-203-937 3850
Fax: +1-203-937 3433
E-Mail: Greg.Greenberg@yale.edu

Source of Funding: None declared.

Abstract

In recent years, lower cost non-physician providers have been increasingly used to deliver outpatient mental health services. We compared 1997 and 2004 data on outpatient services provided by the Veterans Health Administration to examine trends in outpatient provider mix and to evaluate the association of outpatient provider mix with average per capita outpatient mental health costs. We found a small decline in the proportion of outpatient mental health services provided by psychiatrists and an increase in the proportion of such services provided by nurses. These changes were associated with greater, rather than lower per capita outpatient costs and there was no significant change over time. Increasing VA workloads over the past decade have forced increases in psychiatrist panel size, substantially increasing physician efficiency. Additional non-physician staff have supported the development of psychosocial rehabilitation and crisis intervention capacities needed to cope with a 63% decline in inpatient beds and thus have most likely been complements of, rather than substitutes for, psychiatrists.

Background: In recent years, lower cost non-physician providers have been increasingly used to deliver outpatient mental health services.

Methods: We compared 1997 and 2004 data on outpatient services provided by the Veterans Health Administration to examine trends in outpatient provider mix and to evaluate the association of outpatient provider mix with average per capita outpatient mental health costs.

Results: We found a small decline in the proportion of outpatient mental health services provided by psychiatrists and an increase in the proportion of such services provided by nurses. However, greater use of non-physician providers, at the facility level, was associated with greater, rather than lower per capita outpatient costs and there was no significant change over time.

Conclusion: While an increasing proportion of outpatient mental health visits were with non-psychiatrists, there was not an associated decline in per capita mental health costs. Increasing VA workloads over the past decade have forced increases in psychiatrist panel size, substantially increasing physician efficiency. Additional non-physician staff have supported the development of psychosocial rehabilitation and crisis intervention capacities needed to cope with a 63% decline in inpatient beds and thus have most likely been complements of, rather than substitutes for, psychiatrists.

Received 10 December 2005; accepted 1 July 2006