Behavioral Health and Managed Care

By Kathleen Sheridan

In 1995, the Human Capital Initiative, sponsored by the American Psychological Association (APA), its Division of Health Psychology, and the National Institute of Mental Health, released its report, Doing the Right Thing: A Research Plan for Healthy Living.

The report highlighted empirical evidence regarding two highly important health issues. First, among the leading causes of death in the United States are heart disease, cancer, cerebrovascular disease, accidental injuries, and chronic lung diseases. Research indicates that if people at risk for these conditions would alter certain behaviors -- compliance with medical advice, nutritional intake, stress, smoking, exercise, and alcohol and drug use -- the likelihood of disease and the severity of clinical manifestations would be significantly reduced. Second, prevention efforts and behavioral interventions to promote, implement, and sustain healthy life styles are cost-effective and would dramatically reduce health care costs.

The Human Capital Initiative was intended to inform and guide health policy planners and promoters. Last month, however, the APA Monitor summarized the Hay Group Health Care Plan Design and Cost Trends: 1988 through 1997, the first study assessing the effect of managed care on behavioral health interventions. Such interventions include those traditionally associated with and empirically validated for use with DSM IV diagnoses, as well as those useful in reducing risk behaviors linked with the clinical conditions noted above.

The Monitor reports that in the last decade, health insurance companies cut the value of behavioral health care benefits from $154.08 per covered individual in 1988 to $69.61 in 1997. In comparison, the value of other health care benefits dropped only 7%, from $2,326.86 per covered individual in 1988 to $2,155.60 in 1997. In fact, behavioral health care as a percentage of total health-care benefits fell 50% from 6.2% in 1988 to 3.1% in 1997. Additionally, "the limits and caps insurance companies are placing on behavioral health-care benefits have become more stringent.[T]he number of plans that limit visits for outpatient behavioral health care has increased significantly since 1988, when only a quarter of all health plans restricted patients to 50 annual visits. Today, a plan that allows 50 visits is considered generous because nearly half of all health plans limit patients to 20 visits per year."

These data demonstrate an apparent contradiction between what is known and what is practiced in health care. For an industry supposedly concerned both about being responsive to consumers and reducing costs, such widespread disregard of both consumers and economic and societal costs is troubling for health policy decision makers and health promotion advocates.