Differences in medical care expenditures for adults with depression compared to adults with major chronic conditions.
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.


OBJECTIVE
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.


CONCLUSIONS
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.
Lurie
Ithai Z
IZ
Office of Tax Analysis, US Department of Treasury , Washington, DC 20220, USA. ithai.lurie@do.treas.gov
Manheim
Larry M
LM
Dunlop
Dorothy D
DD
D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease / Q000191:economics*; D003866:Depressive Disorder / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D055553:Prescription Drugs