Are psychiatrists cost-effective? An analysis of integrated versus split treatment.
OBJECTIVE
Managed care organizations prefer putatively less expensive split treatment, i.e., a psychopharmacologist plus a non-M.D. psychotherapist. In this study the cost of integrated care by a psychiatrist was compared with split care.


METHODS
Using 1998 fee schedules of seven large managed care organizations (with 54.3% market share and 67.8 million lives) plus Medicare (37 million people), the author modeled clinical scenarios of psychotherapy alone, medication alone, and combined treatment provided by a psychiatrist or split with a psychologist or social worker.


RESULTS
Brief psychotherapy by a social worker was the least expensive treatment. When treatment required both psychotherapy and medication, combined treatment by a psychiatrist cost about the same or less than split treatment with a social worker psychotherapist; it was usually less expensive than split treatment with a psychologist psychotherapist.


CONCLUSIONS
The integrated biopsychosocial model practiced by psychiatry is both theoretically and economically the preferred model when combined treatment is needed.
Dewan
M
M
Department of Psychiatry, State University of New York Health Sciences Center at Psychiatry, State University of New York Health Sciences Center at Syracuse, 13210, USA. dewanm@vax.cs.hscsyr.edu
D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005245:Fee Schedules; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D006278:Medicare / Q000191:economics; D001523:Mental Disorders / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D011570:Psychiatry / Q000191:economics* / Q000379:methods; D011586:Psychology, Clinical / Q000191:economics; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use; D012949:Social Work, Psychiatric / Q000191:economics; D014481:United States