Spending on Depression Up From 1996 to 2005

Increased Florida Medicaid spending but minimal improvements in quality of care

WEDNESDAY, Dec. 7 (HealthDay News) -- Spending for Florida Medicaid enrollees with depression increased considerably from 1996 to 2005, according to a study published in the December issue of the Archives of General Psychiatry.

Catherine A. Fullerton, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues assessed longitudinal trends in health service utilization, spending, and quality of care for depression, among Florida Medicaid enrollees (aged 18 to 64 years), between July 1, 1996, and June 30, 2006. Mental health care expenditures, including inpatient, outpatient, and medication spending were assessed after adjusting for inflation and case mix, and quality-of-care measured, were evaluated.

The investigators found that there was a 29 percent increase in mental health care spending, from a mean of $2,802 to $3,610 per enrollee. The increase resulted primarily from increased pharmacotherapy expenditure (up 110 percent), which was mainly due to antipsychotics (949 percent increase), and occurred in spite of a mean decrease in inpatient spending from $641 to $373 per enrollee. There was a decrease in the percentage of enrollees with depression who were hospitalized (from 9.1 to 5.1 percent), and in those who received psychotherapy (from 56.6 to 37.5 percent). There was an increase in the use of antidepressants (from 80.6 to 86.8 percent) and antipsychotic medications (from 25.9 to 41.9 percent), while anxiety medication use remained unchanged. There were mixed changes in the quality of care, with slightly improved antidepressant use, fluctuating psychotherapy utilization, and decreased follow-up visits.

"We found a substantial increase in spending for patients with depression, with minimal improvements in quality of care," the authors write.

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