SAMHSA.gov
The Substance Abuse & Mental Health Services Administration



SAMHSA.gov

Advancing Health Through System Reform

The following illustrates the large, complex and dynamic nature of the current health environment. The private sector plays a dominant role in individual medical care through private insurance and with public subsidies. Hospitals and ambulatory health care centers are the predominate sites of services. Personal medical care is oriented toward those who actively seek it and the care provided is fragmented across a range of disciplines and providers.

The healthcare financing system (private insurance, out-of-pocket, Medicare, Medicaid, other Federal, state & local government programs) can be confusing with an array of reimbursement rates, deductibles and coverage limits. Total national health services and supplies expenditures were $1.6 trillion in 2003, of which mental health and substance abuse (MH/SA) spending made up 7.5% or $121 billion. Of this amount, $100 billion (83%) was directed toward mental health and $21 billion (17%) was for substance abuse.

Like treatment for most chronic health conditions, MH/SA services largely focus on costly secondary and tertiary services related to severe disability. Despite current and rapidly growing national health expenditures and the vast array of public and private programs, substantial gaps in the service delivery system exist. A growing number of Americans lack health insurance (47 million) and public health service system capacity is eroding.

Public health services, largely funded by government, work to prevent epidemics and the spread of disease, protect against environmental hazards, prevent injuries, reduce risk of illness, promote resilience, encourage healthy behaviors, respond to disasters and assist communities in recovery, and assure the quality and accessibility of health services. Increasing responsibilities to provide medical care for the indigent and uninsured, new and persistent challenges, and funding limitations have seriously eroded the capacity of state and local public health agencies to fulfill their basic community-wide responsibilities.

Understanding our current health system and the determinants of health (behavior, socio-economic status, human biology, environment, and health care) provides context for the national discussion on health reform. Mental health and substance abuse services are an essential component for advancing our Nation's health. The Substance Abuse and Mental Health Services Administration (SAMHSA), states, local governments, providers, consumers and the recovery community are working together to bring the best possible prevention, health promotion, early intervention, treatment, and recovery services to people in need.

Your organization's ideas are welcome. They will be used to gain insight into the options that would help ensure substance abuse and mental health service goals are met in local community environments through health system reform. Please use the attached template as a guide for providing and highlighting important information and perspectives that your organization would like to share. Please limit your submission to no more than 3 pages.

Send all submissions to healthreform@samhsa.hhs.gov. The information your organization provides will be posted on the SAMHSA Web site at www.samhsa.gov/healthreform and will be used to inform upcoming national discussions.


Last Update: 4/10/2009