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Public payers picked up a growing share of the mental health/ substance abuse treatment bill during 1987-1997.
ABSTRACT: This paper is the result of an ongoing effort to track spending on mental health and substance abuse (MH/SA) treatment nationwide. Spending for MH/SA treatment was $85.3 billion in 1997: $73.4 billion for mental illness and $11.9 billion for substance abuse. MH/SA spending growth averaged 6.8 percent a year between 1987 and 1997, while national health expenditures grew by 8.2 percent.
Approximately 28 percent of the U.S. adult population suffers from a mental health or substance abuse (MH/SA) disorder during the course of a year.1 Of the ten leading causes of disability worldwide in 1990, five were MH/SA conditions.2 Given the prevalence of MH/SA-related illness and death, it is important to know how much the United States invests in treatment. Moreover, the rapid advances in treatment technologies and dramatic changes in the organization and financing of the MH/SA treatment system require that this investment be tracked over time.
This paper presents estimates of national MH/SA spending in 1987 and 1997, by payer and type of service, using the most recently available data. We adjust the estimates to enable direct comparisons with total national health care spending. These figures replace and supplement prior spending estimates for 1986-1996 produced by this team because they are based on more recent data and improved methods.3
Study Methods
We used two basic methods to estimate spending on MH/SA treatment depending on provider or service type. The first method relied on the Substance Abuse and Mental Health Services Administration's (SAMHSA's) national surveys of specialty MH/SA organizations. These surveys, the Inventory of Mental Health Organizations (IMHO) and the Uniform Facility Data Set (UFDS), report total revenues by provider, payer source, and diagnosis. Services captured on both surveys were unduplicated. The most important data gap was the lack of data about Mh specialty facility care for 1995-1997.4 Missing revenue data and outliers were imputed or extrapolated.5
The second basic method carved out spending on MH/SA treatment from the Health Care Financing Administration's (HCFA's) National Health Accounts (NHA). The NHA captured several services and providers that the UFDS or IMHO did not, including spending for general hospital nonspecialty units, physicians, other professionals, retail prescription drugs,...