Slide1: SAMHSA National Expenditures on Mental Health Services and Substance Abuse Treatment, 1991 - 2001 Spending by type of provider and payer 10-year trends MH/SA compared to all health expenditures Improvements each round  Revised trends SAMHSA Researchers: The MEDSTAT Group Actuarial Research Corporation The Lewin Group U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration www.samhsa.gov


Slide2: Methods -- Overview Approach: Econometric and actuarial techniques Data Sources: National Health Accounts of CMS – the control totals SAMHSA provider surveys (NSSATS and SMHO) National client-level survey and claims data sets (10)– to parse MH andamp; SA spending by provider and payer Technical expert review


Slide3: General Sector Client-level data by diagnosis and payer 10 data sources, include: NHA, NAMCS, NNHS, NHHHCS, IMS, HCUP-NIS, NMES, MEPS, Rebate use, charges, and payments (including cost sharing and discounts) National Health Accounts Control Totals Specialty Sector Methods Aggregate data from providers/facility surveys by diagnosis and payer Impute missing values, non-response adjust, smoothing SAMHSA Data: IMHO (1986 -1994) andamp; UFDS/ADSS


Scope of Study: Scope of Study Excludes prevention Excludes all dementias Only national level, cannot report by state Excluded non-treatment costs (e.g, productivity, crime) Excluded illness partially a consequence of MHAOD (e.g., cirrhosis of liver)


Slide5: NHDS HCUP-NIS Medicare Program Data MarketScan NMES A: Establish utilization distribution by payer and MHAOD diagnosis B: Establish per diem charges distribution by payer and MHAOD diagnoses C: Establish payment rates (i.e., cost sharing and discounts) distribution by payer and MHAOD diagnoses Calculate by payer the percent of total expenditures by diagnosis, by taking the product of A x B x C Apply percents to NHA contol totals for hospital inpatient services by payer 4 5 3 2 1 DATA METHOD Output: Estimates of MHAOD spending in community hospital inpatient settings 7 6 EXPENDITURES NHA: Control totals by payer Steps for Estimating Community Hospital Inpatient Expenditures


Slide6: Steps for Estimating Specialty Sector Expenditures DATA EXPENDITURES Multi METHODS IMHO UFDS


MH/SA Treatment is 7.5 Percent of Total Health Care Expenditures, 2001: MH/SA Treatment is 7.5 Percent of Total Health Care Expenditures, 2001 SA = 1.3% SA = $ 18.3 billion All Health, 2001 All Health = $1,372.5 B MH = 6.2% MH = $ 85.4 billion U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration www.samhsa.gov MH/SA = 7.5 $104 billion


Slide8: Mental Health Dominates MH/SA Expenditures MH/SA = $104 B MH 82% SA 18%


Slide9: The Proportion of Public Spending in SA Treatment Grew between 1991 and 2001 All SA = $18.3 B Public = $13.8 B Private = $4.5 B All SA, 1991: Public, 62% All SA = $11.4 B Public = $7.1 B Private = $4.3 B All SA, 2001: Public, 76% All Health Public, 45% All Health = $1,373 B Public = $613 B Private = $759 B


Private and Public Average Annual Growth Rate, 1991 - 2001: Private and Public Average Annual Growth Rate, 1991 - 2001 Average Annual Growth Rate


Public Payments to SA Grew Faster: Annual Growth Rates, 1991 to 2001: Public Payments to SA Grew Faster: Annual Growth Rates, 1991 to 2001 Overall SA Growth Rate: 4.8


Spending Shifts by Payer for Substance Abuse Treatment, 1991 - 2001 : Spending Shifts by Payer for Substance Abuse Treatment, 1991 - 2001 * Medicaid includes Federal and State Dollars ** Other Federal includes VA, DOD, Block Grant etc


Private Insurance Expenditures for SA Declines in real Dollars from 1991 to 2001: Private Insurance Expenditures for SA Declines in real Dollars from 1991 to 2001 In Millions of Dollars Total 1991 = 2.5 Billion Total 2001 = 2.7 Billion Ave Annual Growth Rate = negative 1.1%


SA Versus MH Expenditures for All Payers, 2001: SA Versus MH Expenditures for All Payers, 2001 * Medicaid includes Federal and State Dollars ** Other Federal includes VA, DOD, Block Grant etc 22.3%


State & Counties Design and Administer 63% of SA Spending in 2001: State andamp; Counties Design and Administer 63% of SA Spending in 2001


Slide16: Medicaid Portion of SA Spending Growing, But SA Remains Small Part of Total Medicaid $ Of All SUD Tx Spending: Medicaid Portion Total Medicaid Spending: Medicaid SUD Tx as Portion of All MH Svc $ 10% SA $: 1.5% Medicaid $: 19% All SA TX $ 18.3 Billion All Medicaid $ 225.5 B


Care Continues to Shift Away from Inpatient to Outpatient for SA Spending: Care Continues to Shift Away from Inpatient to Outpatient for SA Spending Residential Inpatient Inpatient Residential Outpatient Outpatient 46% 1991 SA = $11.4 billion 2001 SA = $18.3 billion


Public Spending for SA is Increasing for Outpatient and Total Spending, 1991 – 2001 : Public Spending for SA is Increasing for Outpatient and Total Spending, 1991 – 2001 St andamp; Local Medicaid Medicare 2828 Residential 6934 Total +++


SA Spending by Provider, 2001: Specialty SA Center Largest Single Provider: SA Spending by Provider, 2001: Specialty SA Center Largest Single Provider


Specialty SA Centers: Largest Single Provider and Fastest Growing: Specialty SA Centers: Largest Single Provider and Fastest Growing Note: Excludes Insurance Administration: 91 – 5%, 2001 – 6% Note: Retail drugs excluded as 0.4% of Total


Contribution to the SA Expenditure Change: 1991 & 2001 by Type of Provider & Insurance Administration: Contribution to the SA Expenditure Change: 1991 andamp; 2001 by Type of Provider andamp; Insurance Administration Percent Contribution to SA Expenditure Change NH + HH + Drugs, 3% Physician + Other Prof., 7% Specialty Hospitals, 9% General Hospitals, 12% MSMHOs, 12% SSACs, 51% Insurance Admin., 7%


Who is the Payer of Least Resistance? : Who is the Payer of Least Resistance? Decline in Private Insurance Coverage Large Role for States Golden Era of Medicaid-izing Ended Future of SAMHSA Spending Estimates: SEP every 1 to 2 years Projections