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Why Integrate Health, Mental Health and Addiction Services?
There are several reasons to consider integrating these interrelated services. The following list is not intended to be in any order of priority but to stimulate discussion and clarify policy decision-making:
1. Financial: There is widespread belief that health care in general costs far more than the quality and outcomes achieved are worth with current organizational arrangements. Outcomes for health care in the United States are no better (in fact, worse in many cases) than in other highly developed national economies. Recent studies indicate that untreated mental illnesses and addictions account for a disproportionate share of the costs for acute as well as long-term health care. For example, persons with physical health symptoms but no medical explanation account for a high percentage of health care expenditures. Many of these individuals have sub-threshold or undiagnosed anxiety and depression. Another study just released by the Robert Wood Johnson Foundation shows that substance abuse disorders add hundreds of millions of dollars in costs to Medicaid programs alone, especially for older adults who are experiencing the cumulative effects of long untreated addictions. In summary, an increasing share of national expenditures for health care without corresponding increases in quality of care is leading to the unsustainability of current health care cost trends
2. Disease burden: Life expectancy and disease burden, it is hoped, could be improved with more coordinated, integrated and efficient care. The World Health Organization released a report in October 2008, based on extensive government data on the causes of death and impact of disease and injuries, that concludes that neuropsychiatric conditions are among the leading causes of disability in all regions of the world. Furthermore, the study concludes that these disorders account for one-third of "years lost due to disability" (YLD) among people older than 14 years of age. Numerous studies of death among persons with major mental illnesses in the United States show that the average person with such a disorder dies 20-25 years before the average. Oregon's 2008 study matching public mental health and addictions enrollment records indicates that persons with both a mental illness and a substance abuse disorder die at the average age of 44 years.
3. Reduce provider frustrations with multiple accountability, regulatory, billing, administrative and record-keeping functions. Most public providers of health services must navigate complex streams of financing (Medicaid, state General Fund, grants, fee-for-service, private funds, local government contributions, etc) in order to maintain fiscal and programmatic viability.
4. Risk management. Poorly integrated and poorly aligned financial arrangements lead to increased demand on finances for public institutions. State and local governments, schools and communities in general bear considerable risk for poor outcomes related to inaccessible, inefficient and/or ineffective health care systems. These risks range from state hospitals (which will soon cost one-half million State General Fund dollars per patient per biennium) to less expensive but still costly extended and long-term care services; to juvenile and adult criminal justice and corrections costs; school and educational failures; homelessness; and lost economic (and therefore tax revenue) productivity. Unlike private insurance and to some degree private medical/hospital services, government cannot routinely or easily increase rates in order to compensate for uncovered and uncontrolled risks described above.
5. Improved quality of health care and life. Integrated systems of care should provide more holistic and comprehensive care, leading to improved quality of life and improved functioning in all areas of life-from educational and vocational to family and social spheres. |
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