One of the major concerns about the changing U.S. health-care
systems is whether they will improve or diminish the quality and
cost-effectiveness of medical care. The shift from a
fee-for-service to a prepaid method of reimbursement has greatly
changed the incentives of patients to seek care as well as those of
providers to supply it. This change poses a particular challenge
for care of depressed patients, a vulnerable population that often
does not advocate for its own care. This book documents the
inefficiencies of our national systems--prepaid as well as
fee-for-service--for treating depression and explores how they can
be improved.
Although depression is a major illness affecting millions of
people, it is seriously undertreated in the United States. The
ongoing shift of mental-health care away from specialists and
toward primary medical-care providers is causing fewer depressed
patients to be appropriately diagnosed and treated. Depression is
frequently more devastating than other major illnesses, such as
arthritis and heart disease, because it often begins at a younger
age, when people are at their productive peak and thus at risk of
permanently damaging their careers. It also differs from many
medical conditions in that its indirect costs are usually much
higher than direct treatment costs.
The authors urge the integration of both medical and economic
considerations in designing policies for the treatment of
depression. They show that by spending more money efficiently on
care, the nation will gain greater health improvements per dollar
invested and a more productive population.
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