It Just Isn’t Worth That Much: Paying For Mental Illness Prevention

“Price is what you pay. Value is what you get.” ~ Warren Buffett

If Warren Buffet, probably one of very few men in financial history with even remote islands asking him for economic help, tells me I get good bang for my buck, I’m tempted to believe him.

Or at least in areas where it makes sense. It’s true Mrs. Romney may feel she’s gotten real value in that T-shirt she shelled out $1,000 for, and some may beg to differ.

But when it comes to health, it seems that Mr. Buffet just might be on to something.

Or so you’d think.

But turns out that American adults aren’t willing to pay the price for preventative mental health care–even while acknowledging that avoiding mental illnesses would, indeed, have much value.

Starting with the acknowledged fact that

allocation of resources for the treatment of mental illness is low relative to the burden imposed by these illnesses,

Dylan Smith, from the Department of Preventive Medicine at Stony Brook University and his colleagues wondered if public willingness to pay less for mental health treatment was because mental illness was perceived as less burdensome than physical illness.

In his study entitled, “What’s it worth? Public willingness to pay to avoid mental illnesses compared with general medical illnesses,” the researchers described two mental and three general medical illnesses to the subjects, and asked them to rate their perceptions of how burdensome each illness was.

Asked to rate diabetes, partial blindness and below-the-knee amputation, and then depression and schizophrenia for severity and level of debilitation, the respondents generally considered the general medical conditions less ‘severe’ than depression and schizophrenia, and rated schizophrenia as the most ‘burdensome’ illness of all.

Utilizing a scale of 1-100, subjects rated schizophrenia a 63.26, followed by partial blindness at 52.75, and depression at 51.05. Amputation’s burden was 41.26 and that of diabetes a 37.15.

Only after such ratings were they asked what they would pay, out-of-pocket, to prevent the illness. Despite schizophrenia’s win in the burden arena, it did not have the highest ‘willingness-to-pay value.’ And depression, with a relatively high ‘burdensomeness’ rating, came in flat bottom in willingness-to-pay value.

Respondents were willing to pay $100.91 to avoid schizophrenia, but $109.13 to avoid partial blindness, a signficant difference. And although the burden of amputation was perceived as significantly less than that of schizophrenia, what respondents were willing to pay ($98.96) was not significantly different statistically.

Overall, the researchers found, respondents were willing to pay around 40% less to avoid the mental as compared with physical conditions.

As quoted in Medical News Today’s article “Mental Illness Prevention – People Don’t Like Paying,” Peter Ubel, M.D., of Duke University, senior author of the study, said:

All else equal, the general public doesn’t think it is as valuable to treat mental illness as other types of illness. There is a fundamental disconnect between how bad they think it would be to experience depression and their willingness to spend money to rid themselves of the illness.

Dr. Smith said (see “Public Less Willing to Pay to Avoid Mental Illnesses“),

Our results showed that participants understood that mental illness clearly has a very negative impact on quality of life yet we’re significantly not as willing to pay for effective treatments for these illnesses.

Continues Smith:

The findings mirror the general pattern of health care spending, with less resources going to treat mental illnesses than might be expected given the overall level of burden they impose on society.

In point of fact, according to Times’Tallying Mental Illness’ Costs,” only 6.2% of U.S. health care spending is devoted to mental illnesses, while the publication by the World Health Organization, “The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020,” revealed that mental illness accounts for over 15% of disease costs. [Notably, that is more than the financial burden of all cancers combined.]

The authors conclude that

public attitudes influence how much payers for health care are willing to spend to treat mental illness and how likely federal agencies are to invest in research on mental illness.

But remember what Warren Buffet has to say about price and value–or that old saying that ‘you get what you pay for.

We ‘cheap out’ on mental illness prevention at a very great price–to our own health, to the health of Americans in general, and to society’s overall functioning.

We’re just not paying the price for which you get value–which seems quite a foolish way to go about it. Warren Buffet would not approve.


Mental Illness Devalued in Survey

Smith DM, et al “What’s it worth? Public willingness to pay to avoid mental illnesses compared with general medical illnesses.” Psychiatric Services 2012; 63:319–324.

The global burden of disease.  A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020.  (Murray CL, Lopez AD, eds.  World Health Organization, World Bank, Harvard University, 1996.)

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