November 1st, 2011

Can medical students afford mental health treatment?

Medical students experience higher rates of depression, burnout and other mental illnesses yet a new study shows insurance coverage offered by U.S. medical schools significantly limits their treatment for mental health disorders and substance abuse.

Only one out of five medical schools provides complete coverage for mental health and substance abuse treatment without co-pays or coinsurance, researchers at the Harvard-affiliated Cambridge Health Alliance found in their study published in the Sept. 7, 2011 issue of the Journal of the American Medical Association. The first ever survey of such coverage found most medical schools imposed annual visit and dollar limits and cost sharing.

All schools provided some coverage for outpatient mental health treatment, but six schools offered no coverage at all for inpatient mental health and/or substance abuse treatment. Annual dollar limits ranged from $800 to $200,000 for outpatient services and $1,000 to $2 million for inpatient. Annual visit caps ranged from eight to 150.

“We were surprised by the variability in the coverage. Some schools actually had very good coverage. There were some plans that just had really significant barriers,” says lead author Rachel Nardin, M.D., assistant professor of neurology at Harvard Medical School and chief of neurology at Cambridge Health Alliance.

The findings varied widely even among only public schools or only private ones. Researchers also observed wide disparity in the same geographic region, Nardin says.

Data for 115 of the 129 U.S. medical schools was obtained between June and December 2010 from school Web sites; schools with no online insurance information were sent a questionnaire. For schools offering more than one plan, the least expensive plan was recorded.

Median co-payments were $20-$25 per visit for outpatient services and $500 when required for an inpatient stay. Median coinsurance was 20 percent for all services and required by 40 percent of schools for outpatient mental health treatment and 63 percent for inpatient. Coinsurance was 45 percent for outpatient substance abuse treatment and 62 percent for inpatient.

Out-of-pocket costs can discourage seeking treatment when medical students typically graduate with $150,000 in debt from public institutions and $180,000 from private, the Association of American Medical Colleges reports. Students may also avoid getting care for drug and alcohol dependency and other problems for fear their medical records could jeopardize their careers, suggests senior author J. Wesley Boyd, M.D., Ph.D., assistant clinical professor of psychiatry at Harvard Medical School and an attending psychiatrist at Cambridge Health Alliance. Avoiding treatment has long-term risks: Studies have documented physicians have higher rates of suicide than the general population.

“Working closely with physicians and medical students for a long time I’ve been profoundly aware of the need to intervene early,” Boyd says.

Nardin says the study’s goal was not to demonize medical schools but to determine coverage standards offered to our nation’s future physicians.

“It’s kind of a poignant example of the way our insurance system really fails people in our country who become sick,” she says.

By Janine Weisman

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