An Invisible Driver of Medical Costs


One in five Americans are living with behavioral health problems like alcoholism, bipolar disorder, and psychosis. Only about 43% of those who need it currently receive mental health treatment. This is because individuals with behavioral health conditions have long been underserved by a health system that prioritizes medical care over mental health care. As a result of this care gap, mental illness has increasingly contributed to high health care costs and poor health outcomes.

A recent Milliman report found that cost of care for individuals with both behavioral and medical conditions was two to three times higher than for individuals with only medical illness. Researchers analyzed cost and utilization data from insurance claims reports for 21 chronic medical conditions. The conditions included congestive heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension. By grouping behavioral health conditions into three categories—no mental health or substance use disorder, non-serious mental health diagnosis, and serious and persistent mental illness—researchers were able to determine how varying severity of behavioral health impacted total cost of care.

As depicted in the graph, cost of care increased as mental health category worsened. For instance, cost of care for an individual with only congestive heart failure and no mental illness or substance use disorder was $1,713. For individuals with congestive heart failure and a non-serious mental health diagnosis, cost of care increased to $2,479. Cost of care for those with congestive heart failure and significant mental illness was $3,149.

The increased cost of care for people with both behavioral and medical conditions was due to repeating use of medical services. In fact, individuals with behavioral health conditions who are hospitalized for a medical illness typically get readmitted for the same diagnosis within 30 days. Without access to robust mental health services, people turn to medical providers for both their medical and behavioral health conditions and medical facilities are often ill-equipped to address individuals’ behavioral health issues, perpetuating the cycle of higher and costly utilization of medical services.

Ultimately, the link between behavioral health conditions and medical cost calls attention to potential benefits that could be derived from increasing access to quality behavioral health services and the effective treatment of mental health conditions.

Databyte via “Potential economic impact of integrated medical-behavioral healthcare: Updated projections for 2017,” Milliman Research Project, January 2018.