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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. dewanm@vax.cs.hscsyr.edu

Abstract

OBJECTIVE:

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.

METHOD:

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.

RESULTS:

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.

CONCLUSIONS:

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

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