Can telehealth solve mental health inequities?

Summary:

• Mental health inequities cause a high economic burden ($477.5B in 2024)?
• Higher rates of mental health conditions in racial minority and lower income groups correlate with multiple economic burdens. In 2024: Excessive utilization of ED services ($5.3B); Higher cost of managing chronic conditions ($23.9B); Loss of productivity due to unemployment, presenteeism and absenteeism ($116B); Economic losses caused by higher rates of premature deaths($332.2B)?
• Solving mental health inequities will require a systematic approach to overcome political and social determinants of health
• Virtual Primary Care — connecting everyone with a trusted personal primary care physician — is a potentially powerful, effective, and cost-efficient way to reduce inequities by making mental and medical healthcare available to all.?

Economic impact of mental health inequities

A report this month from Deloitte (The projected costs and economic impact of mental health inequities in the United States) calculates the economic impact of inequities in delivery and accessibility of mental and medical healthcare services.?

The reported annual economic burden of mental health inequities in the USA in 2024 is $477.5B, and is projected to rise to $1.26T by 2040.?

Methodology

The authors of this report examined populations of different racial backgrounds, socioeconomic statuses and ages, correlating each group's rate of mental health challenges and chronic medical conditions with their health expenditures and rates of premature death. For racial minorities and lower socioeconomic groups, they document higher rates of mental health conditions and correlate that to higher rates of chronic medical conditions, unemployment, and premature death.

They describe the higher rates of mental health challenges and all the consequent effects as "mental health inequities" and quantify the economic impacts associated with these higher rates. They further posit that all the economic costs attributed to the higher rates of mental health conditions are savings that could be realized if the rates of mental health conditions were the same as in the low risk groups. ?

Results

The press release announcing the report refers to the 2024 cost of $477.5B as an avoidable and unnecessary expense, although their analysis makes it clear that only some of this amount is truly avoidable expense, and that?most is economic burden associated with lost productivity and premature deaths.?

The majority of the economic burden?($332.2 B, or 70%)?was attributed to premature deaths, which they calculated under the assumption that each year of life lost has an economic value of $64,000. That means a 20 year old woman who dies of a substance use disorder (overdose) and does not live for the expected additional 61 years would increase the economic burden calculation by $3.9M.?

Meaning

It may be an overstatement to say that these amounts are avoidable expenses or potential reductions in healthcare expenditures. Just the opposite is true —?addressing these inequities will require greater healthcare spending in order to achieve these potential benefits. Admittedly, the additional healthcare spending would also lead to reduced costs of managing medical conditions —?but other benefits would be quite hard to measure.?

Some savings associated with fixing the mental health inequities would be more immediate: Reduction of $5.3B in excess Emergency Department utilization seems achievable, and some increase in employment could occur, reducing the $116 B in lost workplace productivity and unemployment. Reducing the impact of other health problems, such as diabetes, would require addressing more than just mental and behavioral health issues —?such as nutrition and exercise, and the many factors leading to obesity and poor health.?

Solutions

As the authors point out, reducing the economic burden associated with mental health inequities will require a systems approach to address "political and social determinants of health, which?cause an often-unfair distribution of resources and opportunities."?

At HealthTap we believe that primary care physicians are an important part of the solution to mental health inequities. Not only do they manage the most common mental and behavioral health conditions — from anxiety and insomnia to depression and substance use disorder — but they also prevent and manage the chronic health conditions that are more common in those with mental and behavioral health challenges.?

Take-home message

This report summarizes the inequities in our society caused by not having widely available and accessible medical and mental health services. It underscores why HealthTap's mission solves an important part of the problem of mental health inequities —?by making a trusted personal primary care physician available to everyone, everywhere in the country. And HealthTap does so in the most cost-efficient and effective way possible, via high resolution video virtual consultations with that trusted physician on any mobile device or web browser.