December 12, 2013
Is Mental Health For The Rich? Fewer Psychiatrists Accepting Insurance
Lee Rannals for redOrbit.com - Your Universe Online
New research published in JAMA Psychiatry shows that only individuals with deep pockets are able to afford a psychiatrist these days.
Researchers at Weill Cornell Medical College found psychiatrists are increasingly refusing to accept Medicare, Medicaid and even private insurance as payment. The team found the percentage of psychiatrists who accepted private insurance dropped by 17 percent and those who took Medicare declined by almost 20 percent.
"More than physicians in other specialties, psychiatrists accept lower rates of insurance, and those who don't take insurance are likely charging cash for their services," said the study's lead author Dr. Tara F. Bishop, an assistant professor in the Department of Public Health and Medicine at Weill Cornell Medical College.
The researchers used a nationally representative survey for the study that represented 90 percent of the ambulatory care delivered in the US. The database did not include psychiatric outpatient clinics linked to hospitals or large medical centers. Bishop said patients with some of the most severe mental illnesses may be cared for in those clinics, and this database does not look at that population.
She said the number of psychiatrists is also declining because they are retiring and medical students are not choosing the field of study. The researchers are worried all of these conditions could lead to problems or more mental health disorders going undiagnosed nationwide.
"In the current climate, where the need for increased mental health services is now recognized, I suspect our study conclusions will be an eye opener for both the public and the medical community," Bishop says. "I must say we were surprised by the findings. No prior studies have documented such striking differences in insurance acceptance rates by psychiatrists and physicians of other specialties - primarily because no one has looked closely at the issue."
The team said low insurance rates may impact recent calls for increased access to mental health services, and if the trend of declining acceptance rates continues then the impact may be even more significant.
"For example, not only are there fewer physicians who can help people with moderate to severe symptoms of mental illness, those patients must then try to find a doctor who will take their insurance," Bishop says. "This is not a formula for success."
According to the Centers for Disease Control and Prevention (CDC), a quarter of adults in the US report having some sort of mental illness, and about half of adults will suffer from one in their lifetime.
The team said they are not sure why psychiatrists are rejecting insurance payment, and questions about motivation were not included in the survey. However, they speculate insurance provides lower reimbursement rates than psychiatrists feel cover the costs of care. Bishop says another reason could be that it takes a long time to provide counseling and therapy, so psychiatrists may not be able to see as many patients in a day as physicians or other specialists can.
Another consideration for why psychiatrists are not accepting insurance is because about 60 percent of them practice alone, and accepting insurance entails considerable administrative work. The study found these solo practitioners are less likely to accept all types of insurance.
Bishop said the team is planning to further their research by interviewing psychiatrists to understand why they are not accepting these forms of payment.