Factors affecting costs in Medicaid populations with behavioral health disorders.

BACKGROUND: Persons with behavioral disorders incur higher healthcare costs. Although they utilize behavioral health (BH) services others do not, they also have higher utilization of medical services OBJECTIVES: : To determine the degree to which higher costs for persons with BH disorders are attributable to utilization of BH services, multiple chronic medical conditions (CMCs) or other issues specific to populations with BH disorders. RESEARCH DESIGN: Data base consisted of claims for 63,141 Medicaid beneficiaries, 49% of whom had one of 5 categories of BH disorder. Generalized linear models were used to identify relative impact of demographics, BH status, multiple CMCs and primary care access on total, behavioral, nonbehavioral, and medical/surgical costs. RESULTS: Number of CMCs was associated with significant increases in all cost categories, including behavioral costs. Presence of any BH disorder significantly influenced these same costs, including those not associated with BH care. Effect size in each cost category varied by BH group. CONCLUSIONS: BH status has a large impact on all healthcare costs, including costs of medical and other non-BH services. The number of CMCs affects BH costs independent of BH disorder. Results suggest that costs might be reduced through better integration of behavioral and medical health services.

Low costs of defensive medicine, small savings from tort reform.

In this paper we present the costs of defensive medicine in thirty-five clinical specialties to determine whether malpractice liability reforms would greatly reduce health care costs. Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.