Friday, September 22, 2006

Medicine: Luxury Child Psych Care: Value or Class Privilege?

NPR covers the story of Amy, a 16-year old rich kid who was severely depressed. Amy, fragile in her middle-upper class menagerie, couldn't handle what sounds like a pretty dungeonesque child psych wing of a general hospital. Her rich parents found Sheppard Pratt's Overlook program. Overlook is $1700/ day, and doesn't take insurance, because, well, insurance won't pay $1700/day for psychiatric care.

My gut reaction, which isn't my final reaction, is a general a resounding WTF?!?! What business does an academic medical center have creating psychiatric hotels? Why is an academic medical center filling a luxury-care market niche? Why does Amy get to be "Amy times ten," as she says, while kid in the ghetto can't even be "Kid in the Ghetto times one."?

But class-warfare Sparky loses out to cost-efficiency Sparky every time:

Psychiatrist Vaeth doesn't have the data, but he thinks Overlook could prove cheaper than multiple short-term stays at other hospitals, and that insurers might learn from some of Overlook's approaches.

"If this program flourishes and does well and people say, 'Wow, if you have $1,700 a day, you will do well psychiatrically,' then why couldn't we develop a similar program but maybe scaled down to $1,000 a day?

That's closer to what insurance companies might be willing to pay.

Right now, Overlook is half full, and some other hospitals are considering luxury care, such as the Harvard-affiliated MacLean, which already offers an intensive therapy program. That program has fewer amenities like private rooms, but it is sometimes covered by insurance.

Amy left Overlook after four months, at a cost of about $200,000. Her aunt says her niece has gained enormous perspective and strength. Amy thinks so, too.
I admit that I'm not particularly going into child psychiatry to treat the children of parents who can afford 200k out of pocket hospital expenses and not launch the entire family into a deep, dark depression (which isn't to say I wouldn't happily treat them, or that I wouldn't accept out of pocket payment!). For 200k, I bet I could gain enormous perspective and strength too.

But Vaeth has a point that I can't even start to deny, which is that luxury psychiatric care (or at least a lot nicer than the white-walled dungeon Amy describes in the audio clip) might very well be a lot cheaper to the system if it allows a child to be accurately diagnosed and started on a treatment plan that will allow them to avoid multiple hospitalizations (and lost childhood to mental illness) in the future.

So, let's get NIMH to fund a study where poor kids can go to Overlook as well. Let's follow them for a few years, and let's find out if it pays for itself, or not. If not, let's at least leave the mint-on-pillow approach to the private sector.

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