
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, August 22, 1993                   TAG: 9312100273
SECTION: EDITORIAL                    PAGE: F3   EDITION: METRO 
SOURCE: LOUIS A. PERROTT
DATELINE:                                 LENGTH: Medium

CONTROLLING HEALTH COSTS

DURING HIS presidential campaign, Bill Clinton succeeded in reminding all of us, ``It's the economy, Stupid!'' Now he is banking on accelerating the economy by reducing health-care costs, and American corporations seem to agree.

I recently heard a businessman announce with alarm that his company's annual expenditures for health-care costs had exceeded its corporate profit for that year. By 1995, about 20 percent of our total national gross domestic product will go to meet health-care costs, up from about 14 percent in 1992.

Clearly, something must be done now to reverse this trend. What are the solutions? Restrict the amount of service provided? Restrict who can use the service, how often, and under what conditions?

When it comes to physical-health care, these solutions seem inhumane, if not also unethical. However, when the focus shifts to reducing mental-health costs, these solutions seem reasonable to some.

But when is more actually less? Answer: when we are talking about mental-health services.

Since at any given time only 15 percent to 18 percent of Americans have a diagnosable mental-health problem, it can be argued that only a minority of beneficiaries is involved. But Americans with a mental disorder have twice as many visits to their primary physicians as those without. This drives up health-care costs. Treating their mental disorders reduces these visits and the costs of physical-health care.

At least 60 percent of all problems that bring in patients to see their physicians have significant stress and emotional causes. To drastically limit, or to not cover mental-health services at all, will result in more use of physical health-care resources.

If the emotional aspects are ignored, physical disorders with accompanying emotional disorders bring patients in again and again to see their physicians. This, too, drives up health-care costs.

Mental-health treatments lower medical expenditures. One study of 10,000 Aetna beneficiaries clearly showed continuously dropping medical costs over a three-year period after mental-health treatment was initiated. Some 20,000 participants in the Columbia Medical Plan increased their medical utilization by 61 percent during a one-year period when their mental conditions went untreated. Blue Cross and Blue Shield of Western Pennsylvania reduced its monthly medical cost per patient from $16.47 to $7.06, following outpatient mental-health treatments.

When is more actually less? To not include mental-health services in any national health-care reform plan would be a drastic mistake.

Worse, to severely restrict mental-health services so as to clamp their effectiveness in reducing physical health-care resources is myopic. Ready access to high-quality, cost-effective mental-health care is a part of the solution to our nation's health-care problem, and not, as some say, a major cause of the problem.

More mental-health services will result in less overall health-care costs. More are essential, for any comprehensive reform plan to be effective in reducing our nation's health-care costs.

\ Louis A. Perrott is a licensed clinical psychologist in private practice in Roanoke and in Salem.

by CNB