Background: Despite increasing consensus about the value
of depression disease management programs, the field has
not identified which stakeholders should absorb the
relatively small additional costs associated with these
Aims of Study: This paper investigates whether two
stakeholder groups (health plans and employer purchasers)
in two delivery systems (rural and urban) economically
benefit from improved depression treatment by testing
whether depression care management results in: (1) a
greater reduction of utilization costs in insured rural
patients than their urban counterparts (health plan
stakeholders), and (2) a greater reduction in work costs
in employed urban patients than their rural counterparts
(employer purchaser stakeholders). Methods: We examined
the main and differential effects of intervention on
utilization and work costs over 24 months in a
preplanned secondary analysis of 479 depressed patients
from rural and urban primary care practices who
participated in a randomized controlled trial of
depression disease management.
Results: Reductions in work costs were observable in both
the rural and urban cohort, while reductions in
utilization costs were observable in the urban cohort.
Discussion with Limitations: While our small sample size
limits definitive conclusions, the economic incentives to
assure improved depression treatment may differ across
stakeholders in rural and urban delivery systems.
Implications for Health Policy: Employers may have more
consistent economic incentives than health plans to
assure improve depression treatment across rural and
urban delivery systems.