Most Med Schools Offer Subpar Mental Health Coverage

By Deborah Brauser
Medscape News Today, Sept. 6, 2011

Most medical schools in the United States do not offer health insurance plans that sufficiently cover mental health or substance abuse treatment, new research suggests.

In fact, only around one third of the schools evaluated offered unlimited monetary and visit benefits.

"Visit and dollar limits are common features of medical student insurance coverage for [mental health treatment] and [substance abuse treatment]," write lead author Rachel Nardin, MD, assistant professor of neurology at Harvard Medical School in Cambridge, Massachusetts, and chief of neurology at Cambridge Health Alliance, and colleagues.

In addition, "fewer than 22% of the schools provide first-dollar coverage without cost sharing," they add.

The investigators note that this is particularly "worrisome" because past research has shown that requiring copayments or coinsurance often discourages students from seeking help for their mental health or substance abuse problems.

They write that although these findings may not be any worse than those found for nonstudent populations, "this parity is not reassuring given the importance to the medical profession and patients of aggressively treating these disorders."

The study results were reported in a Research Letter in the September 7 issue of the Journal of the American Medical Association.

Plans Vary Widely

In the study, the investigators evaluated data on health insurance plans offered by 115 of the 129 US medical schools.

Results showed that although some outpatient mental health coverage was provided through health plans from all of the schools assessed, 6 schools did not offer inpatient coverage of either mental health or substance abuse treatment.

Only 37.4% of the schools provided unlimited outpatient coverage for mental health treatment, and only 28.6% provided it for substance abuse treatment. Unlimited inpatient mental health or substance abuse treatment was provided by 43.2% and 36.4%, respectively.

In addition, only 13 of the schools offered complete outpatient mental health coverage without cost sharing, and 17 provided it for outpatient substance abuse treatment. A total of 22 and 23 schools provided complete inpatient mental health and substance abuse treatment coverage, respectively.

Finally, the median coinsurance rate to be paid by a student was 20% for all services.

Dr. Nardin noted in a release that the plans also varied greatly in terms of annual limits. "At least 1 plan limited annual coverage for outpatient substance abuse care to $800, while another covered the same services up to $200,000 per year."

"Everyone, including medical students, deserves full access to all needed care," she added.

Senior author J. Wesley Boyd, MD, assistant clinical professor of psychiatry at Harvard, said in the same release that these medical students experience higher levels of psychological distress including depression and suicidality, than their peers.

"Such distress correlates with decreases in empathy and altruism…and with increases in medical errors," he reported.

Dr. Nardin said that the best solution for this situation is a national single-payer health insurance program that would offer comprehensivebenefits without copays or coinsurance.

"That message needs to be heard once again in Washington."

The study was supported in part by an Institutional National Research Service Award. The study authors have disclosed no relevant financial relationships.

JAMA. 2011;306:931-933. Abstract