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Harvard Medical School researchers find limited access to pediatric mental health care in five major U.S. cities

Simulated patient study points to long wait times, bias against Medicaid patients and misinformation by private insurers

FOR IMMEDIATE RELEASE, May 10, 2017
Contact: Clare Fauke, communications specialist, PNHP, 312-782-6006 or clare@pnhp.org
J.Wesley Boyd, M.D., Cambridge Health Alliance, 617-833-1840 or jwboyd@cha.harvard.edu

A new study published in the International Journal of Health Services  found that access to outpatient mental health care for children—whether with a child psychiatrist or a pediatrician—is very limited, even for those with private insurance or the ability to pay out of pocket for care. Almost one-fifth of children and adolescents in the United States suffer from a serious mental disorder, but fewer than half of those needing care receive treatment. Researchers found several roadblocks to obtaining timely care, including longer wait times for psychiatric appointments versus pediatric appointments, a lack of providers accepting Medicaid patients and incorrect contact information provided by the insurer.

The study attempted to replicate the experience of a parent trying to obtain needed psychiatric care for a child. Using the Blue Cross Blue Shield (BCBS) online database of in-network providers, the authors called child psychiatrists and pediatricians in the Boston, Seattle, Minneapolis, Chapel Hill, and Houston metropolitan areas. Researchers called the offices of 601 pediatricians and 312 child psychiatrists claiming to be the parent of a 12-year-old child with depression seeking the earliest possible appointment. The authors altered their proposed method of payment, randomly stating either that they 1) carried BCBS PPO insurance, 2) carried Medicaid, or 3) were willing to pay out of pocket for care.

The roadblocks to care include the following:

  • Longer wait times for psychiatry appointments: Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Appointments were obtained with 40% of pediatricians but only 17% of child psychiatrists; the mean wait time for psychiatry appointments was 30 days longer than for pediatrics. Research has shown that long wait times for mental health appointments can negatively impact a person’s engagement in care.
  • Limited access for children on Medicaid: Callers were less likely to obtain appointments for children on Medicaid (22%) than for those with private insurance (37%) or the ability to pay out-of-pocket (37%). Measures to increase physicians acceptance of public insurance, such as higher physician reimbursement and decreased administrative paperwork, may help improve access for patients with Medicaid.
  • Incorrect contact information listed by insurer: One of the most common barriers to making appointments was incorrect or outdated provider information listed on the BCBS site, suggesting that insurance companies may not be vigilant about maintaining accurate databases. “Given how difficult it can be for parents to obtain needed mental health care for their children, insurance companies need to ensure that their provider lists contain accurate information and are as user-friendly as possible,” said lead author Shireen Cama, M.D., a child psychiatry fellow at Cambridge Health Alliance and Harvard Medical School.

Analysis: Private insurers lack incentive for improving access to care

Senior author J. Wesley Boyd, M.D., Ph.D., an attending psychiatrist at Cambridge Health Alliance and faculty member in psychiatry and in the Center for Bioethics at Harvard Medical School, observed that under America’s fragmented, for-profit health insurance system, private insurers do not have an incentive to ensure better access to care. “We found that rosters of health professionals provided by insurance companies often include providers who have either left a practice location, are no longer accepting new patients, or simply aren’t listed with a correct phone number,” said Dr. Boyd. “Insurance companies profit when their enrollees are unable to access care, and patients suffer as a result. We need to take the profit motive out of health care and adopt a single payer, Medicare for all system that guarantees care for patients, not profits for insurers.”

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“Availability of outpatient mental health care by pediatricians and child psychiatrists in five U.S. cities,” Shireen Cama, M.D., Monica Malowney, M.P.H., Anna Jo Bodurtha Smith, M.D., M.P.H., Margaret Spottswood, M.D., M.P.H., Elisa Cheng, M.D., Louis Ostrowsky, M.D., Jose Rengifo, M.D., J. Wesley Boyd, M.D., Ph.D. International Journal of Health Services, May 9, 2017. A copy of the full study is available to media professionals upon request from Clare Fauke, clare@pnhp.org or 312-782-6006.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and educational organization of more than 21,000 doctors who support a single-payer national health program. PNHP had no role in funding or otherwise supporting the studies or commentary described above.