A fraction of the population unnecessarily requires a lopsided share of medical attention, but a new study by a Brigham Young University professor says marital and family counseling could help balance the scales.
D. Russell Crane, director of BYU's Family Studies Center, studied the effect of therapy on people who visit doctors most frequently. His findings, featured in this month's issue of the Journal of Marital and Family Therapy, show that marriage and family therapy result in a 53 percent reduction in medical visits.
"The major concern is for cases where the use of medical services is not clearly necessary," said Crane, a professor of marriage and family therapy. "Often an emotional or mental health condition is involved and needs to be addressed."
The study examined "high utilizers" of health care — people who had made four or more trips to a doctor during a period of six months. This over-treated group presents substantial dilemmas for health care companies and insurers, such as how to deal with their health concerns without tying up medical resources which could be used in a more cost-effective way.
"If some people are using health care unnecessarily, everyone pays because we share the costs of health insurance," Crane said.
The 65 participants in the study were culled from the rolls of an HMO that covers marriage and family therapy for its patients. They were either self-referred for therapy or referred by medical staff. Just six months after beginning therapy, participants had already significantly cut back on seeing a doctor.
The decreased use of medical services following counseling occurs because mental and physical health are somewhat interdependent, Crane said. Just as having a physical ailment affects one's state of mind, having emotional problems can weaken one's physical health. In therapy, the most common diagnoses for high utilizers were relationship problems, mood disorders and anxiety disorders. Therapy can also help families be more supportive of a family member suffering from chronic illness and lessen the need for medical care.
"With the help of therapy, people can deal with life more effectively and reduce stress," said Crane, who is also a practicing marriage and family therapist. "This reduces the possible tendency for emotional concerns to be expressed physically."
Surprisingly, the study determined it does not matter whether a high utilizer attends family therapy as the problem patient or just as a tagalong. In one typical scenario, parents sign up for therapy because a child is struggling and the whole family attends each session. But the parents, who may be high utilizers of health care, also benefit. Despite their attending for the sake of another family member, these individuals saw a 57 percent reduction in medical visits.
Crane also found that marriage and family therapy are just as effective as individual counseling in decreasing high utilizers' trips to the doctor, making family therapy even more cost-effective because at least two people are treated at a time.
The average person attending marriage or family counseling sees a 21.5 percent reduction in medical visits, according to a study Crane authored in 2000. That and other studies have established what mental health professionals call the "offset effect," but little had been done to determine if such an effect existed for high utilizers. The new findings suggest therapy can offset medical costs the most when applied to high utilizers of health care.
"This makes a strong argument that health plans should include coverage for marriage and family therapy," Crane said. "It should at least be a choice."
Two of Crane's former students co-authored the study, David D. Law — who works now for Utah State University-Uintah Basin, and Jerica M. Berge, who is now a doctoral candidate in marriage and family therapy at the University of Minnesota.
Writer: Joseph Hadfield