Between 2007 and 2016, psychiatrists who were accepting new patients participated in insurance networks at lower rates than physicians who were not psychiatrists. This was one of several conclusions of a report published yesterday in Psychiatric Services, which also revealed that the gap in insurance acceptance between psychiatrists and nonpsychiatrists was wider for Medicare and Medicaid than for private insurance.
“The reluctance of psychiatrists to participate in insurance networks substantially threatens mental health access, equity, and public health,” wrote Andrew D. Carlo, M.D., M.P.H., of Northwestern University Feinberg School of Medicine and colleagues. “Although our findings highlight this problem more clearly than have previous studies, our observations cannot directly inform an overarching strategy to mitigate the deleterious market forces that have led to the inequities and inadequacies in the contemporary U.S. mental health care delivery system.”
Carlo and colleagues analyzed 10 years of data (January 2007 to December 2016) from the National Ambulatory Medical Care Survey (NAMCS), an annual survey that provides information about medical services in the United States collected from medical records. From these data, they calculated the differences between psychiatrists and other physicians in the sample. They next calculated the proportions of psychiatrists across all years and in two-year groupings between 2007 and 2016 who accepted Medicare, Medicaid, capitated private insurance, noncapitated private insurance, any private insurance, any public insurance, and any insurance. These calculations were repeated with nonpsychiatrists, and the results of the two groups were compared.
The unweighted sample included on average 4,725 physicians per two-year time group between 2007 and 2016; on average, 307 (7%) of these physicians were psychiatrists.
For all insurer groupings and periods, nonpsychiatrists accepted insurance at higher rates than psychiatrists, Carlo and colleagues reported. “Most notably, we found that, although all physicians working in solo practices and those in [metropolitan statistical areas] were less likely to accept insurance than their counterparts in group practices and outside of [metropolitan statistical areas], these trends were more pronounced among psychiatrists,” they wrote.
“Much has been written about the individual and contextual factors that underpin psychiatrists’ lack of insurance acceptance and disproportionate acceptance of self-pay patients, relative to nonpsychiatrists,” including “relatively low reimbursement rates for mental health services (often lower than rates for nonpsychiatrist physicians for the same service), comparatively arduous administrative burden due to a lack of insurance parity enforcement,” and more, the researchers wrote. “Our findings did not directly support any of these hypotheses or propose alternative explanations, but they have provided a higher-resolution description of the phenomenon, which may improve understanding of this problem.”
“Much has been written about the individual and contextual factors that underpin psychiatrists’ lack of insurance acceptance and disproportionate acceptance of self-pay patients, relative to nonpsychiatrists,” including “relatively low reimbursement rates for mental health services (often lower than rates for nonpsychiatrist physicians for the same service), comparatively arduous administrative burden due to a lack of insurance parity enforcement,” and more, the researchers wrote. “Our findings did not directly support any of these hypotheses or propose alternative explanations, but they have provided a higher-resolution description of the phenomenon, which may improve understanding of this problem.”
In an email to Psychiatric News, Carlo noted that “one of the challenges that people face in accessing psychiatric care is poor insurance network adequacy, leading to prohibitively high out-of-pocket costs for patients and their families.”
“Our findings suggest that much more needs to be done at various levels of the health care system to bring more psychiatrists and other mental health providers into public and private insurance networks,” he continued. “Possibilities include incentives for psychiatrists, enforcement of federal insurance parity laws, and other policy strategies. Psychiatrists can help facilitate change by advocating for enforcement of insurance parity laws and working with their local and regional societies/networks to identify strategies to improve network adequacy.”
For related information, see the Psychiatric News Alert “Survey Reveals Stark Difficulty in Obtaining Appointments With Child Psychiatrists” and the Psychiatric Services article “Patient Characteristics and Treatment Patterns Among Psychiatrists Who Do Not Accept Private Insurance.”
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