ABSTRACT

Ever since the medical cost offset was discovered more than 35 years ago (Cummings et al., 1962) at the Kaiser Permanente health maintenance organization (HMO), the most important argument for the inclusion of behavioral healthcare in primary care has been that it saves medical and surgical costs, and reduces inappropriate physical utilization. Since that seminal research (Follette & Cummings, 1967; Cummings & Follette, 1968), researchers have conducted scores of studies, many of which elicited the medical cost offset effect, while others did not. In order to be meaningful, the savings in medical utilization must exceed the costs of providing the behavioral healthcare interventions. Some studies have shown a negative effect, painfully demonstrating that traditional mental healthcare services cannot be parachuted into a traditional medical delivery system without incurring disappointing results.