Imagine for a moment you are suffering from an illness that makes you feel like your soul has been run over by an angry defensive lineman, a disease that interferes with your desire to sleep, eat and make love. Oh, and this illness will continue to make you feel this way for the rest of your life. How much would you be willing to pay for a treatment makes you feel normal again?
My colleagues and I posed that question to a nationally representative sample of more than 700 Americans and we discovered something troubling—people’s willingness to pay for medical interventions depends in large part on whether the illness in question is “physical” or “mental.” People are much less willing to part with money to treat mental illnesses, even after accounting for the perceived severity of those same illnesses. Our article—“What’s It Worth?”—is available online at the Journal of Psychiatric Services.
Let me tell you a bit more about our study. We described a handful of illnesses to people and asked them to tell us, in effect, how bad each one would be to experience. For instance, we describe type 2 diabetes to people, and told them that it was uncomplicated by any other medical problems. People thought that would be pretty hard on their quality of life. We also described below-the-knee amputation, and they thought that would be even worse than diabetes. We described severe blindness, which only leaves one able to distinguish shadows. People thought that one was worse than either of the first two problems.
We also described a case of moderately severe depression to people, a level bad enough to cause the victims to “feel sad and downhearted a lot of the time.” The description went on to explain that it would make people “feel like a failure” and lose interest in food and sex. Trust me, it was a thorough and devastating picture of how depression can affect people’s lives. Indeed, people thought it was horrendous, at least as bad as any of the physical illnesses we described.
We also provided people with a description of schizophrenia, and that even trumped depression. In other words, people were able to recognize that mental illness can have a huge negative impact on people’s lives.
So why then does our country care so little about mental healthcare? Why do, say, psychologists and psychiatrists make so much less money than orthopedic surgeons and anesthesiologists? Why is federal funding for treatment of mental illness so much lower than for diseases that cause much less burden to society? Perhaps it is because their treatments aren’t as good, or because they don’t perform procedures that require great skill and training?
Well here’s another reason—people don’t seem to value such treatments as much as they value treatments of physical illness. You see in our study, after eliciting people’s perceptions of these five illnesses, we asked them how much they would pay, out of pocket, for a pill “that would allow you to permanently and completely avoid ever having” the condition in question.
People told us they would pay large amounts of money to avoid blindness and diabetes. But when it came to things like depression and schizophrenia? Even though these illnesses were judged by those same people, as being equally bad or even worse than blindness, they were only willing to pay 60% as much to avoid it.
Something strange is going on here.
Mental health advocates have long complained, rightly, that the general public doesn’t place a high enough priority on preventing and treating mental illness. Federal funding for mental illness lags behind other types of disease, relative to the burden these illnesses place on people’s lives. Advocates have responded by emphasizing just how bad mental illnesses are, believing that if people just understood what a burden they place on people, they would pony up.
Our study shows that this problem is bigger and more daunting than mental health advocates though. It is not just that people fail to appreciate how bad mental illness can be. Even when they acknowledge its burdens, they don’t believe much money should be spent preventing or treating such illnesses.
Am I the only one who finds these attitudes a little, well, depressing?
Peter Ubel is a physician, behavioral scientist and author of Pricing Life: Why It’s Time for Health Care Rationing and Free Market Madness. He teaches business and public policy at Duke University. Peter’s new book, Critical Decisions will be available in the fall of 2012. You can follow him on his personal blog.