Exploratory evidence on the market for effective depression care in Pittsburgh.
OBJECTIVE
Despite the existence of effective and relatively cost-effective depression treatments, many depressed patients do not receive appropriate care. The authors assessed opportunities for increasing the rate of effective depression treatment by investigating the market for such treatment in the Pittsburgh area.


METHODS
A conceptual framework was developed to evaluate the market for effective depression care. On the basis of the conceptual framework, interviews were conducted with representatives from seven large employers, two medical health insurance carriers, two behavioral health insurance carriers, four primary care providers, and four behavioral health care providers. Respondents were asked to assess the barriers to and opportunities for increasing the rates of depression treatment from their perspectives.


RESULTS
The findings suggest that there is currently little demand among purchasers for improving depression care and little interest among insurers and providers for improving care in the absence of purchaser demand. Even stakeholders who identified depression as an important problem could not come to a consensus about who should be responsible for addressing the problem. Employers reported that they look primarily to their vendors to initiate quality improvement efforts, whereas insurers reported that such improvement efforts were more likely to occur if they were initiated by employers who purchase their health plans; providers, in turn, reported feeling powerless to initiate change.


CONCLUSIONS
The absence of a clear locus of responsibility for improving depression care lends considerable inertia to the status quo. Because the currently low treatment rates are likely to be socially inefficient, researchers and policy makers should consider strategies to help overcome this inertia.
Schoenbaum
Michael
M
RAND, Arlington, Virginia 22202, USA. mikels@rand.org
Kelleher
Kelly
K
Lave
Judith R
JR
Green
Stephanie
S
Keyser
Donna
D
Pincus
Harold
H
D002391:Catchment Area, Health; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics* / Q000628:therapy*; D017049:Employer Health Costs; D006264:Health Benefit Plans, Employee; D019981:Health Care Sector; D006801:Humans; D007358:Insurance, Psychiatric; D008605:Mental Health Services / Q000592:standards* / Q000600:supply & distribution; D020380:Needs Assessment; D009786:Occupational Health Services / Q000600:supply & distribution; D010414:Pennsylvania; D011785:Quality Assurance, Health Care; D012941:Social Responsibility; D011795:Surveys and Questionnaires