Health Affairs

From Health Affairs

First Comprehensive Report On The Department Of Veterans Affairs’ Mental Health Treatment System

Bethesda, MD -- A new study, released online today as a Web First by Health Affairs, found that in 2007, despite being only 15.4% of the VA patient population, veterans with mental illness and substance use disorders accounted for 32.9 percent of all Veterans Health Administration (VHA) costs ($12 billion), of which the majority was for non-mental health conditions, such as diabetes and hypertension. The quality of the veterans’ care varied by as much as twenty-three percentage points among regional service networks. Those findings were part of a study the US Department of Veterans Affairs asked the Altarum Institute and the RAND Corporation to conduct in 2006. This is the first study on VHA costs and quality to focus on more than two mental disorders and compare regional differences in care.

Care For Veterans With Mental And Substance Use Disorders: Good Performance On Many Measures, But Still Room For Improvement By Katherine E. Watkins, Harold Alan Pincus, Susan Paddock, Brad Smith, Abigail Woodroffe, Carrie Farmer, Melony E. Sorbero, Marcela Horvitz-Lennon,Thomas Mannle Jr., Kimberly A. Hepner, Jacob Solomon, and Cathy Call http://content.healthaffairs.org/content/early/2011/10/17/hlthaff.2011.0509 Watkins, Paddock, Farmer, Sorbero, Horvitz-Lennon, Hepner, and Solomon are affiliated with the RAND Corporation; Pincus is with Columbia University’s College of Physicians and Surgeons in New York City; Smith, Woodroffe, and Call are with the Altarum Institute; and Mannle is with Pilot Consulting Services in Gloucester, MA. This study will also appear in the November issue of Health Affairs.

The authors examined the care provided to all veterans who received services from the VHA in fiscal year 2007 for treatment of at least one of these illnesses: schizophrenia, bipolar I disorder, post-traumatic stress disorder (PTSD), major depression, and substance use disorders, a population of 836,699.

Some key findings:

• The percentage of veterans with mental and substance use disorders increased by 38.5 percent between 2004 and 2008, with the largest growth in veterans affected by PTSD.
  
  
• In fiscal year 2007, the average cost of treatment for a veteran with a mental illness or substance use disorder was $12,337, while the average cost of care for a veteran without one of these disorders was $4,579. For mental health treatment, the proportion of veterans receiving recommended care varied widely – and fewer than one-third of those identified with schizophrenia or bipolar disorder received continuous maintenance medication treatment, thus making relapse and rehospitalization more likely.
  
  

“The size of the veteran population with mental and substance use disorders is likely to continue to increase, as military operations in Iraq and Afghanistan decrease in size and service members leave the armed forces,” say the authors. “Given the clinical complexity and health care costs associated with these disorders, identifying ways to increase efficiency while improving quality is critical.”

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.

The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.