Limiting Access to Psychiatric Services Can Increase Total Health Care Costs

Restricted access to health care services and medication is associated with overall higher utilizationand higher health care costs. Although randomized controlled trials (RCTs) are regarded as thebest method of determining whether a treatment strategy does more good than harm, clinical practiceimprovement (CPI) methods may be a more effective way of achieving superior medical outcomes forthe least cost over the course of a patient’s care. The Managed Care Outcomes Project, a large-scaleCPI study, tracked detailed factors regarding medical care, patients, and outcomes from differentmanaged care settings. Results showed that cost-containment strategies employed by various healthmaintenance organizations were associated with poor treatment outcomes for patients and in fact increased total health care costs. Psychiatric illnesses were underdiagnosed, and care ranged from patientsreceiving psychiatric medications without a psychiatric diagnosis to patients with a psychiatricdiagnosis receiving no psychiatric treatment at all. Cost-containment strategies appeared to limit psychiatricreferrals, frequency of psychiatric visits, and use of certain antidepressants (i.e., selective serotoninreuptake inhibitors). Further, the severity of the primary physical illness in the study populationwas associated with greater psychiatric illness. The fact that treatment was inconsistent andfrequently inappropriate shows the need for better diagnostic and management protocols.