Half of psychiatrists reject private and federal insurance, preferring cash

December 11, 2013

NEW YORK (December 11, 2013) -- Access to mental health care has become a prominent issue in Congress following mass shootings around the country. But a new study in JAMA Psychiatry, led by researchers at Weill Cornell Medical College, suggests that unless those in need of help have deep pockets, they might have a hard time finding a psychiatrist that will provide the needed services.

The study found that psychiatrists increasingly refuse to accept Medicare and Medicaid, or even private insurance, as payment. In the five years between 2005 and 2010, investigators found that the percentage of psychiatrists who accepted private insurance dropped by 17 percent, to 55 percent, and those that took Medicare declined by almost 20 percent, also to about 55 percent. Their acceptance of Medicaid is 43 percent, the lowest among all medical specialties.

"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," says 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 number of psychiatrists is also quickly dwindling -- a drop of 14 percent from 2000 to 2008 -- because psychiatrists are retiring and medical students are not choosing to go into psychiatry. These issues may lead to a perfect storm of untreated mental health issues nationwide, Dr. Bishop says.

"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," she 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."

These 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," the researchers say in their study.

"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," Dr. Bishop says. "This is not a formula for success."

Additionally, with the growth of the population, need for services will increase, she says. The Centers for Disease Control and Prevention estimates that a quarter of adults in the United States report having a mental illness at any given time, and that about half of adults will suffer from one in their lifetime.

While the term "mental illness" is broad, and includes depression and anxiety that general care doctors can help with, those doctors are overwhelmed, says Dr. Bishop, who is herself a primary care physician. "We don't have a work force that can keep up with all the issues -- mental health aside -- in our growing and aging population."

Solo practitioners less likely to accept insurance

The Weill Cornell investigators, working with researchers from Columbia University and the University of California, San Francisco, used a nationally representative survey to conduct their study. That database is the National Ambulatory Medical Care Survey (NAMCS), administered by the Centers for Disease Control's National Center for Health Statistics (NCHS). It represents about 90 percent of the ambulatory care delivered in the United States -- the care provided in private physician offices or group practices, Dr. Bishop says.

The database does not include psychiatric outpatient clinics linked to hospitals or large medical centers. "Some patients with some of the most severe mental illnesses, such as schizophrenia or bipolar disease, may be cared for in those clinics, and this database does not capture that population," she says.

The average number of physicians surveyed each year by the NAMCS is about 1,250, and psychiatrists represent 5.5 percent of these doctors.

The researchers don't know why psychiatrists are increasingly rejecting insurance payment; questions about motivation were not included in the survey. "But we can speculate that insurance provides lower reimbursement rates than psychiatrists feel cover the costs of care," Dr. Bishop says.

Part of the reason for this reluctance may be that it takes considerable time -- typically, an hour or so -- to provide counseling and therapy, and therefore, psychiatrists may not be able to see as many patients in a day as physicians of other specialties can, Dr. Bishop says.

Additionally, more psychiatrists than physicians of other specialties practice alone -- 60 percent -- and accepting insurance entails considerable administrative work, she says. The study found that these solo practitioners are less likely to accept all types of insurance.

These issues could be resolved if incentives are offered to medical students to pursue psychiatry, and if insurance payments to practicing psychiatrists are increased, the researchers say.

Dr. Bishop is delving deeper into the issues her study raises. She plans to interview psychiatrists to understand why they are not accepting insurance, and what can be done to change their minds.
Co-authors of the study are Dr. Matthew Press, from Weill Cornell Medical College, Dr. Salomeh Keyhani, from the University of California, San Francisco, and Dr. Harold Alan Pincus, from Columbia University and NewYork-Presbyterian Hospital. Dr. Bishop is supported by a National Institute on Aging Career Development Award (K23AG043499). She and Dr. Press are Nanette Laitman Clinical Scholars in Public Health at Weill Cornell Medical College. Dr. Keyhani is supported by a VA HSR&D Career Development Award.

Weill Cornell Medical College

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside, aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

Office of External Affairs
Weill Cornell Medical College
tel: 646.317.7401
email: pr@med.cornell.edu
Follow WCMC on Twitter and Facebook

Weill Cornell Medicine

Related Mental Health Articles from Brightsurf:

Mental health strained by disaster
A new study found that suicide rates increase during all types of disasters -- including severe storms, floods, hurricanes and ice storms -- with the largest overall increase occurring two years after a disaster.

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

World Mental Health Day -- CACTUS releases report of largest researcher mental health survey
On the occasion of 'World Mental Health Day' 2020, CACTUS, a global scientific communications company, has released a global survey on mental health, wellbeing and fulfilment in academia.

Mental illness, mental health care use among police officers
A survey study of Texas police officers examines how common mental illness and mental health care use are in a large urban department.

COVID-19 outbreak and mental health
The use of online platforms to guide effective consumption of information, facilitate social support and continue mental health care delivery during the COVID-19 pandemic is discussed in this Viewpoint.

COVID-19 may have consequences for mental health
The COVID-19 pandemic appears to be adversely affecting mental health among hospitalised patients, the healthcare professionals treating them and the general population.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental ill health 'substantial health concern' among police, finds international study
Mental health issues among police officers are a 'substantial health concern,' with around 1 in 4 potentially drinking at hazardous levels and around 1 in 7 meeting the criteria for post traumatic stress disorder and depression, finds a pooled data analysis of the available international evidence, published online in Occupational & Environmental Medicine.

Examining health insurance nondiscrimination policies with mental health among gender minority individuals
A large private health insurance database was used to examine the association between between health insurance nondiscrimination policies and mental health outcomes for gender minority individuals.

Mental health care for adolescents
Researchers examined changes over time in the kinds of mental health problems for which adolescents in the United States received care and where they got that care in this survey study with findings that should be interpreted within the context of several limitations including self-reported information.

Read More: Mental Health News and Mental Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.