Simple Gifts

PREVENTION FOR EVERYONE:
A Strategy for Deficit Reduction & Health Care Cost Containment 

The prevention of mental, emotional and behavioral disorders is possible, and such prevention is also highly cost-efficient for economic, health, safety and free-enterprise conditions of America. The recent Institute of Medicine Report (March, 2009)on the Prevention of Mental, Emotional and Behavioral Disorders (MEB) presents a compelling summary of the evidence for how many of America’s human ills can be easily and cost-effectively prevented.1 We can now efficiently prevent such costly and deadly disorders such as: 

• Depression,
• Attention Deficit Hyperactivity Disorder (ADHD),
• Oppositional Defiance disorder,
• Conduct disorders,
• Bipolar disorder,
• Learning and cognitive disabilities,
• Child abuse,
• Violent crime, and
• Lifetime addictions.

We Can Reduce America’s Heavy Burden from These Problems Inexpensively

The above behavioral (MEB) conditions are responsible for almost all runaway health-care, public safety and educational costs in America. These costs are crippling our economic competitiveness. Yet, many of our major competitors in Europe and Australia and Asia are not so impacted, since they have lower rates of these behavioral conditions. Why? Because they have adopted the IOM scientific findings for “behavioral vaccines” that originated in America to their own advantage years ago.

How much will it cost to prevent these expensive problems? Less than we pay presently for the cost CDC-approved vaccines for childhood diseases such as Diphtheria, Measles, Pertussis, Mumps, Rubella or even the flu. Such CDC-approved vaccines cost presently $20 per $130 per child in America , and are standard feature of all government and private health-care plans or initiatives.

We can provide some “behavioral vaccines” for depression, ADHD, oppositional defiance, conduct disorders, other psychiatric disorders, learning disabilities and lifetime addictions for approximately $15 to $20 per child in the population.1-8 Other behavioral vaccines are more expensive, similar in cost to Measles, Mumps, Rubella and Varicella vaccine (MMVP) at $130 per child. What is a “behavioral vaccine”?

A behavioral vaccine is a repeated behavior—scientifically proven—that reduces or prevents morbidity (sickness) or reduces mortality (death).4 9 10 Hand washing is a simple example, which even prevents serious illnesses such as H1N1 Influenza. Infant car-safety seats or bike helmets are more sophisticated examples. Behavioral vaccines can have large public health, public safety and business or productivity effects at a very modest cost.7 11-16

Behavioral vaccines have to be universally accessible to have major public health, public safety and business productivity effects. Thus, we provide soap and water in virtually all public restrooms; similarly, practically every child in America has a car seat or bike helmet available—either from blended funding or from public and private sources.

By example, the Institute of Medicine Report documents the promise of behavioral vaccines…

• Prevent child-maltreatment, ADHD, and Conduct Disorders economically via universal access to parenting supports,5 6 12 which are widely available in the United Kingdom, the Netherlands, Australia, etc.17-21
• Prevent ADHD, oppositional disorder, learning disabilities, conduct disorder, lifetime addictions, and violent crime via simple supports for elementary teachers.4 22-28
• Prevent or reduce learning disabilities and various DSM-IV disorders using a behavioral vaccine reflecting “grandmothers’ wisdom” as well as randomized trials sponsored by the National Institutes of Health.7 8 29

Assuring Universal Access to Effective Behavioral Vaccines for Prevention

Behavioral vaccines—like medical vaccines—can only protect the country if enough people have actual access to the scientifically proven prevention protocols. The sheer cost effectiveness and efficiency of behavioral vaccines warrants their widespread use to reduce heavy fiscal burdens for such rapidly rising costs and related problems as psychotropic medication or abuse of prescription painkillers in schools, homes and the workplace. In the United States, 7% of our children are on psychotropic medications versus 2.9% of the children in the Netherlands.30 This difference is profound, given all children are insured in the Netherlands and Dutch children, parents and teachers have far more access to the behavioral vaccines described in the IOM Report than US citizens. Worse still, the discovery of these powerful behavioral vaccines have been discovered and tested in the United States.
Reimbursing Delivery of Behavioral Vaccines in School or Related Community Settings

Under the Medicare Catastrophic Coverage Act of1988 (P.L. 100-360) school districts are allowed to receive payment from Medicaid for health services delivered to Medicaid-eligible children with disabilities who may need diagnostic, preventative, and rehabilitative services; speech, physical and occupational therapies; and transportation for such services. Only a handful of school districts presently bill for any preventative behavioral vaccine cited in the Institute of Medicine Report, while highly ineffective procedures may be widely reimbursed at present.

Publication and promotion of how to be reimbursed for the scientifically proven behavioral vaccines noted in the IOM Report could have a rapid impact (18-24 month) return on investment for reducing costs for health-care, social service, special education, property crime, and violent crime. This cost-efficiency and return on investment is established in various studies.5 6 31

Significant reduction in the need for prescription psychotropic drugs for children and youth is certainly predicted for such prevention.5 22 32 This has significant impact on cost containment and reduction of the budget deficit for the Federal government and the states as more children are on Medicaid or S-CHIP.33 In Medicaid alone in one Southern state,33 ADHD prevalence among children increased 1.70-fold from 3.10% of beneficiaries in fiscal year 1995-1996 to 5.27% in 2003-2004, paralleled by a 1.84-fold increase in drug use to 4.63%. One in five white boys between the ages of 10 and 14 years received ADHD medication in 2003-2004 while on Medicaid.

With approximately 5.5 million Caucasian boys alone in America, roughly half are likely to qualify for Medicaid or S-CHIP. If 20% of those boys wind up on the least expensive form psychotropics—generic methylphenidate, the total cost at about $70 per month per child is $2.4 billion. Please note this does not include private health insurance. Unlike the proven long-term benefits of the behavioral vaccines documented in the Institute of Medicine Report,1 the long-term studies by the National Institutes of Health show medications for ADHD typically stop working or require a new medication in 14 months or so.34 Some behavioral vaccines not only have long term effects on the externalizing disorders of childhood but also long-term effects on health, behavior, educational study and criminality as much as 20 years later23-27—at less than the cost of five children receiving one month’s supply of medication.

Schools can expect to see much less immediate costs associated with special education and 504 plans, which now is consuming 30% or more of most school districts’ general funds. There are good published studies, some cited in the IOM report, which show that various behavioral vaccines can reduce special education needs and costs substantially, while also advancing academic success or cognitive development.8 24 35-37

Since school districts may claim reimbursement for the administrative costs of providing school-based Medicaid services such as outreach for enrollment purposes, and coordination and/or monitoring of medical care, we have a robust system in place for reaching large numbers of children, families and teachers with effective behavioral vaccines without the need to build new infrastructure.

Nationwide, it is estimated that Medicaid expenditures for school-based services totaled about $2.9 billion in FY 2005. Roughly $2.1 billion of these expenditures were for direct services in schools (including transportation) and $834 million was spent for school-based administrative activities. Given the existing structure of this legislation and the commitment of the current administration and Congress to assure this vehicle, factoring in the IOM Report emphasis on the cost-effectiveness of these early prevention approaches, we need to take clear steps to make them reimbursable for budget deficit reduction, improved outcomes in public health, public safety and economic vitality.

Next Steps
1. Assure the regulations and legislation fully support Medicaid and S-CHIP reimbursement of faithful and robust implementation of cost effective early prevention strategies described in the IOM Report.
2. Assure that the federal parity provisions on mental, emotional and behavioral disorders provide the same reimbursement that supports faithful and robust implementation of these strategies by private insurance.
3. Develop a mechanism for providing reimbursement of new and possibly better “behavioral vaccines” in the future.
4. Develop a scientifically valid way to assess the impact of this policy shift for both behavioral outcomes and cost-efficiency.

Bibliography

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