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Sherry Glied On Mental Health And Mandates



May 26th, 2010

The Senate Finance Committee is scheduled to vote today on the nomination of Sherry Glied to be the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services. The President nominated Glied, a professor and chair of the department of Health Policy and Management at Columbia University’s Mailman School of Public Health, on May 21, 2009. Glied served as a senior economist for healthcare and labor market policy to the President’s Council of Economic Advisers under both President George H.W. Bush and President Clinton. She was a participant in President Clinton’s Health Care Task Force and headed working groups on global budgets and the economic impacts of Clinton’s reform plan.

The Well-Being Of People With Mental Illness. Glied coauthored the lead article in Health Affairs’ May/June 2009 thematic issue on mental health. She and Richard Frank found that the well-being of people with mental illnesses had improved in important ways during the period from 1950 to 1996, and that many of these gains were sustained during the decade from 1996 to 2006:

The burden of out-of-pocket costs for people with mental disorders either remained constant or declined. Providers’ willingness to serve insured people expanded. Quality of care for major mental disorders continued to improve, especially in the area of pharmacotherapy, but it was uneven and sluggish in other areas of treatment. Finally, despite pressures on the availability of low-income housing, homelessness has remained steady in recent years, and the relative incomes of people with mental illnesses show marginal improvement.

However, Glied and Frank also noted some disturbing trends, particularly for those who were seriously mentally ill.For adults impaired by a mental illness, rates of treatment remained essentially constant through 2006; for the elderly, they actually declined,” they reported. In a discussion with relevance for the current debate over the legitimacy of nonquantitative restrictions to care under mental health parity regulations, the authors wrote:

The beneficial effects of continued growth in managed behavioral health care, which facilitated access to care for people with less serious illnesses, may simply have bypassed this group. Alternatively, the expansion of managed care may have diverted resources from those with serious illnesses toward the less seriously ill.

Glied and Frank also pointed to rising psychiatric hospitalization rates since 2000 for children and adults, “which may reflect either a lack of community care or a return to a more balanced mix of treatment modalities.” They said the most disturbing trend has been growing incarceration of people with serious mental illnesses. At a release event for the issue May/June issue, Glied labeled incarceration “a real black hole in our assessment of the well-being of people with mental illness. Our current estimate is that about 7 percent of the population with serious and persistent mental illness is in jail or prison, and that’s a pretty terrible statistic.”

Evaluating Mandates. In the November/December 2007 issue of Health Affairs, Glied coauthored an article that was influential in the debate over whether to include an individual mandate in health reform legislation. In “Consider It Done? The Likely Efficacy of Mandates for Health Insurance,” Glied, Jacob Hartz, and Genessa Giorgi surveyed compliance with health insurance individual mandates in the Netherlands, Switzerland, and Hawaii, as well as compliance with mandates in other areas ranging from automobile insurance to child support. They found that “high-compliance situations share several features: Compliance is easy and relatively inexpensive; penalties for noncompliance are stiff but not excessive; and enforcement is routine, appropriately timed, and frequent.”

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