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Am J Psychiatry. 1999 Feb;156(2):324-6.

Are psychiatrists cost-effective? An analysis of integrated versus split treatment.

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  • 1Department of Psychiatry, State University of New York Health Sciences Center at Psychiatry, State University of New York Health Sciences Center at Syracuse, 13210, USA.



Managed care organizations prefer putatively less expensive split treatment, i.e., a psychopharmacologist plus a non-M.D. psychotherapist. In this study the cost of integrated care by a psychiatrist was compared with split care.


Using 1998 fee schedules of seven large managed care organizations (with 54.3% market share and 67.8 million lives) plus Medicare (37 million people), the author modeled clinical scenarios of psychotherapy alone, medication alone, and combined treatment provided by a psychiatrist or split with a psychologist or social worker.


Brief psychotherapy by a social worker was the least expensive treatment. When treatment required both psychotherapy and medication, combined treatment by a psychiatrist cost about the same or less than split treatment with a social worker psychotherapist; it was usually less expensive than split treatment with a psychologist psychotherapist.


The integrated biopsychosocial model practiced by psychiatry is both theoretically and economically the preferred model when combined treatment is needed.

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