July 1st, 2017

Shortage of prompt care for children highlighted

Appointment availability is low – and wait times, long – for a family seeking care for a child with depression, according to a recent study.

The study, published by the International Journal of Health Services, from Harvard Medical School researchers and others, found that access to outpatient pediatric mental health care, whether with a child psychiatrist or a pediatrician, in the five metropolitan areas used in the study was limited, even for those with private insurance or willing to pay out of pocket – although it was even more difficult for those on Medicaid.

The authors used the Blue Cross Blue Shield online database of in-network providers, and identified and called child psychiatrists and pediatricians in each of the five metropolitan areas (Boston, Seattle, Minneapolis, Houston, and Chapel Hill, N.C.), claiming to be the parent of a 12-year-old child with depression and seeking the earliest possible appointment.

Authors called the offices of 601 pediatric physicians and 312 child and adolescent psychiatrists in the five cities and after up to two attempts, obtained appointments with 40 percent of the pediatricians and 17 percent of the child and adolescent psychiatrists.

Those indicating they were self-pay or had private PPO insurance obtained an appointment 37 percent of the time, but those who identified their insurance type was Medicaid secured an appointment 22 percent of the time.

The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments (42.9 days versus 12.7 days).

Senior author J. Wesley Boyd, M.D., Ph.D., an attending psychiatrist at Cambridge Health Alliance and also a faculty member in the Center for Bioethics at Harvard Medical School said the study emphasizes the shortage of access to child psychiatric care, as callers were much more likely to secure an appointment (and sooner) with the pediatric provider.

“There’s a huge shortage of child psychiatrists, which is why primary care has to pick up the slack and pediatricians often end up being the mental health person for kids,” Boyd said. Boyd said another reason calls to pediatricians may have been more successful is that pediatricians tend to have a better infrastructure in their offices, in terms of having more office staff to help field calls and schedule appointments.

The most common barrier to making an appointment was that the phone number listed in the provider directory was incorrect. Reasons include that the provider no longer worked at that office, the provider was not accepting new patients or that it was an outright wrong number.

The study said those findings suggest that insurance companies may not be vigilant about maintaining accurate databases and that consumers may be attracted to plans offering larger networks, not realizing that the actual access and availability of providers is far less than what is initially perceived.

Boyd said those findings echoed a previous study he performed, in which the authors were trying to schedule adult psychiatric appointments in three cities. Among wrong numbers in that study was one for a jewelry store and another for a fast food chain. “The overall picture is that there are tons of wrong numbers listed in a database maintained by insurance companies,” Boyd said.

“This is really, to me, a stain on the insurance companies, for not making it as straightforward and easy as possible to obtain care when you need it,” Boyd said.

Boyd said some insurance companies have begun sending reminders to doctors to update their contact information and status in online databases. “They are trying to put the burden on practitioners,” Boyd said. But if a doctor has left a practice, for example, he or she may never receive the request to update information, if it is delivered to an old address or email.

Boyd said given that insurance companies profit when patients are not able to access needed care, he would like to see health reform that doesn’t involve the private insurance system.

“I’m a very big supporter of a single payer system and also eliminating the profit motive in medicine,” Boyd said. He said he has optimism, in part because “Young people have awakened and are motivated to speak out.”

“When Obamacare passed through, I thought it was better than nothing, but it’s not the solution,” Boyd said. “The amazing thing is – because of Obamacare, the dialogue has changed, even among conservatives, so that at this point, it is risky for a politician to say he doesn’t care about healthcare. That’s a huge shift. That’s monumental.”

By Pamela Berard

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