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Addressing the Cost of Health Care From the Front Lines of Psychiatry

Andres Barkil-Oteo, MD, MSc1; David A. Stern, MD2; Melissa R. Arbuckle, MD, PhD3,4
[+] Author Affiliations
1Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
2Department of Psychiatry, New York Medical College, Valhalla
3Department of Psychiatry, Columbia University Medical Center, New York, New York
4New York State Psychiatric Institute, New York
JAMA Psychiatry. 2014;71(6):619-620. doi:10.1001/jamapsychiatry.2014.121.
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The escalating cost of health care in the United States has been described as an unsustainable crisis. This high cost does not always translate into better outcomes. Financial expenditures frequently outweigh the clinical benefits, resulting in low-value care.

While medical professionals at large have begun to consider potential solutions for addressing high costs and low-value care, psychiatrists have been relatively insulated from the discussion for 2 reasons: their infrequent use of the costliest medical procedures and the diffusion of their highest cost factor, psychiatric medications, across a wide number of medical specialists. The bulk of antidepressants and antianxiety medications, along with half of antipsychotics, are prescribed by other health care providers and specialties.1 However, in 2006, Americans paid a total of $57.5 billion for mental health services. This makes mental health care the third most expensive medical treatment in the nation, second only to heart conditions and trauma, and tied with cancer.2 These numbers reflect the direct cost of care; including the indirect costs that result from patients’ loss of productivity and disability makes the situation worse.

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