Hidden Wounds, Unhidden Costs

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Vets with mental-health ills need a disproportionate share of VA care / Rand-Altarum

A new report out this week – combined with a new report out last week – suggest there will be hefty costs associated with taking care of the nation’s post-9/11 veterans. This week’s report, released Wednesday, says vets with mental-health ailments require a lot more treatment, at far higher cost, than those without such ills. Last week’s report made clear that a greater share of post-9/11 vets have mental-health problems than older vets.

The new report concludes:

There is a large and growing population of veterans with severe and complex general medical, mental, and substance use disorders including schizophrenia, bipolar I disorder, PTSD, and major depression.

The study, by the Rand Corp. and the Altarum Institute, and published in the journal Health Affairs, sifted through data from the Department of Veterans Affairs for 2007. It found that while vets with mental-health issues constituted 15.4% of all vets getting VA care, they accounted for 32.9% of VA health-care spending. Most of that went to treat physical ailments like high-blood pressure or diabetes, conditions that can be exacerbated by poor mental health. “In fiscal year 2007, veterans with serious mental illnesses accounted for nearly half of the acute inpatient discharges and outpatient encounters,” the study said, “and the total costs of their care exceeded $10 billion.”

Mentally-ill vets required a disproportionate share of VA spending “as a result of much higher use of both inpatient and outpatient physical and mental health care services,” the study said. “The average cost for a veteran with mental illness and substance use in our study was $12,337, or 2.7 times the cost for an average veteran without these conditions.”

While only 4% of the vets studied had served in Afghanistan or Iraq, that cohort requires more mental-health treatment than prior generations of veterans. Last week, the Government Accountability Office reported that 38% of post-9/11 vets seeking VA care need mental-health services, compared to 28% of older veterans.

“The size of the veteran population with mental and substance use disorders is likely to continue to increase, as military operations in Iraq and Afghanistan decrease in size and service members leave the armed forces,” the Rand-Altarum study said. “Given the clinical complexity and health care costs associated with these disorders, identifying ways to increase efficiency while improving quality is critical.” Which leads to the report’s lone bit of good news: “Where comparable data are available, the VA performs as well as or better than private plans, Medicare, or Medicaid.”