Public Less Willing to Pay to Avoid Mental Illnesses

An analysis of a nationally representative sample of 710 adult respondents reveals that the public is less willing to pay to avoid mental illnesses compared to paying for treatment of medical conditions. The study, led by Dylan M. Smith, Ph.D., of Stony Brook University School of Medicine, also found that participants recognized mental illnesses as burdensome, in fact more burdensome than some general medical illnesses, yet were willing to pay 40 percent less than what they would pay to avoid medical illnesses. The research results are published in the April issue of Psychiatric Services.

The study respondents were recruited from an internet panel managed by Knowledge Networks, a U.S. survey research firm that maintains a panel of more than 60,000 households that are a representative sample of adults age 21 and over. The respondents were presented with five health conditions. These included three medical illnesses or conditions (diabetes, below-the-knee amputation, and partial blindness), and two mental illnesses (depression and schizophrenia). Participants rated each health condition for severity and level of burden in relation to quality of life. Then they indicated how much they would pay, out of pocket, to avoid the condition.

"Our results showed that participants understood that mental illness clearly has a very negative impact on quality of life yet were significantly not as willing to pay for effective treatments for these illnesses," says Dr. Smith, Lead Author of "What's it Worth? Public Willingness to Pay to Avoid Mental Illnesses Compared with General Medical Illnesses," and Associate Professor of Preventive Medicine in Stony Brook's Center for Medical Humanities, Compassionate Care, and Bioethics.

"The findings mirror the general pattern of health care spending, with less resources going to treat mental illnesses than might be expected given the overall level of burden they impose on society," explains Dr. Smith. He cites current World Health Organization statistics that indicate mental illnesses account for 15.4 percent of the total burden caused by all disease in industrialized countries, yet mental illnesses account for only 6.2 percent of U.S. health care expenditures.

"All else equal, the general public doesn't think it is as valuable to treat mental illness as other types of illness," says Senior Author Peter Ubel, M.D., of Duke University. "There is a fundamental disconnect between how bad they think it would be to experience depression and their willingness to spend money to rid themselves of the illness."

Respondents generally considered the medical illnesses or conditions as less severe in comparison to the mental illnesses. Yet, when respondents were asked to rate the "burdensomeness" of each condition, schizophrenia received the highest mean burden score, but it did not have the highest willingness-to-pay value. Similarly, despite a relatively high "burdensomeness" rating, depression received the lowest median willingness-to-pay value.