Fewer psychiatrists taking insurance; mental healthcare could see impact

Fewer psychiatrists are accepting public and private forms of insurance, according to a new study, raising questions as to whether efforts to increase access to behavioral healthcare could be hindered by a shortage of available providers.

The study, published Wednesday in the journal JAMA Psychiatry, found that 55% of psychiatrists in 2010 accepted private insurance, compared with 89% of physicians within other medical specialties. The rate at which psychiatrists accepted Medicare and Medicaid reimbursement was also much lower than other specialties. The study found 55% of psychiatrists accepted Medicare payments compared with 86% of physicians in other specialties, while 43% of psychiatrists accepted Medicaid compared to 73% of other doctors.

“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,” said lead author Dr. Tara Bishop, assistant professor at Weill Cornell College's Department of Public Health and Medicine. “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 study also found the number of practicing psychiatrists declined 14% from 2000 to 2008, leaving a winnowed supply in the number of doctors in the profession at a time when demand in mental health and substance abuse care services are expected to rise.

About 15 million Americans receive mental health services, according to the National Institute of Mental Health. Mental health and substance abuse treatment are among the 10 essential benefits the Patient Protection and Affordable Care Act requires all health plans to cover beginning on Jan. 1. Last month, the Obama administration issued final rules to the 2008 Mental Health Parity and Addiction Equity Act that requires health plans to offer the same deductibles, copayments and limits on visits for mental health services as they offer for medical and surgical services.

“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 said. “This is not a formula for success.”

Lower reimbursement rates are cited as a possible reason why a declining number of psychiatrists are willing to accept reimbursement from private insurers—17% fewer between 2005 and 2010. Another is that about 60% of psychiatrists are independent, more than in other specialties, and may be unwilling to take on the administrative work that's involved.

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