With depression now the leading cause of disability in the U.S., a new study concludes that employers would get a lot more value for their health care dollar if they covered treatment costs and encouraged depressed workers to seek care.
Researchers asked people how many days in the past month they could not work or conduct normal daily activities because of depression-related problems. They found that depressed workers were either absent or ineffectual on the job 1.5 to 3.2 days during a month-long period. These conditions affected employers' productivity as well as their bottom lines. Even though employees were absent or unproductive, employers still paid them $182 to $400 in salaries over this period; this is about as much as the direct costs of some types of depression treatment, according to the study featured in the September/October 1999 issue of the journal Health Affairs. The fall issue is devoted to the topic of mental health care quality and includes articles by leaders in the field.
Researchers analyzed data from two national surveys: the National Comorbidity Survey, which included interviews with slightly more than 8,000 persons between the ages of 15 and 54 conducted from 1990 to 1992; and the Midlife Development in the U.S. Survey, which included interviews with more than 3,000 persons between the ages of 25 and 74 conducted from 1993 to 1995.
The findings make clear that "employers are losing value not only in terms of worker productivity lost to depression but also in the profit that labor brings in," said Ronald Kessler, professor in the Department of Health Care Policy at Harvard Medical School and one of several coauthors of the study. Worker absenteeism resulting from clinical depression costs employers $17 billion a year, so pushing depressed workers to get help could be very cost-effective for many employers.
"It seems likely that some employers--especially those with a large white-collar workforce--would realize gains in productivity that partially offset the costs of treatment if they were to encourage their depressed employees to obtain treatment," the study concludes. The authors found that between 45 percent and 98 percent of treatment costs would be offset by increased work productivity associated with remission from depression symptoms.
Despite these findings, employer-sponsored mental health benefits remain limited in many American companies, and few employers actively conduct outreach to get their workers to take advantage of benefits they have. Some employers, in fact, have cut as much as 30 percent in both mental health service use and costs in recent years.
Such action could raise costs to employers, however. According to another study in the same issue of Health Affairs, one large corporation's general health costs and sick days went up when mental health use and costs were tightened. The study, by researchers affiliated with the Yale University School of Medicine, found a 37 percent increase in use of non-mental health services and significantly increased sick days among employees who had been relying on mental health services.
The study used data from 1993 to 1995 on mental health service use, non-mental health service use, and sick days among 20,814 employees who had health insurance via a major U.S. corporation. During those years, the company instituted cost containment policies to address rising health costs, including higher deductible and copayment responsibilities. The authors found that reduced mental health service use was associated with increased general health service use and increased work absences among mental health service users.
The authors found no significant changes in the pattern of inpatient mental health use, but they did find a substantial 34 percent drop in the number of days of outpatient mental health service use per patient per year, from 14 days per patient to 9.2 days. And while there was no significant change in inpatient general health service use, there was a large increase in the proportion of employees who used outpatient non-mental health services, from 63.5 percent to 75.8 percent over that period.
Total costs of mental health services per user dropped significantly (37.7 percent) over those three years as a result of benefit limits. But non-mental health services were provided to 18.4 percent more employees in 1995 than in 1993.
The study also found that mental health users had more sick days than other employees. There was an average increase of 1.4 sick days per year (22 percent) among mental health service users, compared with a decrease of 0.4 days per year among non-mental health service users.
"It appears that in this corporation, cutting mental health care resulted in worse consequences for employees with mental health problems, with very little gain for the employer," says Robert Rosenheck, professor of psychiatry and public health at Yale and one of the study's coauthors. "If reducing mental health care is associated with increased medical service use and costs, it may be inferred that use of mental health services prior to these reductions was restraining such costs," he adds.
Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the September/October issue will be provided free to interested members of the press. Funding for the issue of Health Affairs focusing on mental health was provided by the John D. and Catherine T. MacArthur Foundation. To obtain a copy, contact Judie Tucker at Health Affairs at 301-656-7401, ext. 200. The Table of Contents can be obtained by visiting the journal's Web site: http://www.projhope.org/HA . For information about the journal, contact Andrea Zuercher, 301-656-7401, ext. 247.
Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org > (202) 387-2829.
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