Online ISSN: 1099-176X Print
Copyright © 2009 ICMPE.
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
of Tax Analysis, US Department of the Treasury, Washington DC, 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
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.
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.
Copyright © 2009 ICMPE