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Public Health System Delivered Mental Health Preventive Care Links to $824 Reduction of Per Capita Healthcare Costs Annually
Background: Local health departments (LHDs) are positioned at the center of community health programs and play a valuable role in delivering the Essential Public Health Services, including serving as providers of last resort for vulnerable populations. Research is still needed to increase our understanding of how LHDs can be effectively integrated with community partners to improve prevention of and treatment for mental illness.
Objective: To estimate the association of health care expenditures with implementation of preventive mental health programs by LHDs. We hypothesize that LHDs’ provision is cost-effective from a societal perspective, i.e. LHDs’ inexpensive provision of preventive care is associated with lower total health care expenditures.
Method: We constructed a unique multi-level data set at individual, LHD, community, and state levels. The main data set was the 2012 Medical Expenditure Panel Survey, a nationally representative survey, which provided comprehensive information on respondents’ health care expenditures, as well as their demographic and socioeconomic status. MEPS data were linked to the National Association of County and City Health Officials Profiles Survey, the Area Health Resource File, and US Census data using zip-codes. Our key predictor was LHDs’ provision of population-based primary prevention activities for mental illness, and the connection between LHD and community services. Multi-level nationally representative data sets were linked to test the hypothesis that LHDs’ provision of preventive mental health programs was associated with cost-savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs’ mental illness prevention services with total healthcare expenditures for adults aged 18 and above.
Results: Approximately 17% of individuals lived in zip codes where LHDs were involved in the provision of preventive care for mental illness. Regression results showed that direct LHD performance of population based mental illness prevention activities was significantly associated with lower health care expenditures (coef=-0.23, p<0.05). Based on the cost equation, we further estimated that LHD-led provision of population based prevention of mental illness was associated with $824 reduction (95% CI: -$1,562.94 to -$85.42, p<0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics.
Conclusion: As the United States seeks to control healthcare spending, it is essential that local organizations such as LHDs be involved in the coordination of preventive service delivery. Based on our observation of an association we suggest that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions such the expanding the Public Health 3.0 infrastructure.
Future work: we used a cross-sectional design to examine the association between health care expenditures and LHDs’ mental health promotion activities in the above analysis. Our research team has constructed a nationally representative longitudinal data set that will be used to refine the estimation. Data merge has been approved by the AHRQ. Team members will visit the AHRQ data center in the spring to finalize the analysis.