Just getting that first appointment with a private psychiatrist is a difficult process and having insurance doesn’t make it easier, according to a new study by Harvard Medical School researchers.
“Having insurance does not mean having access to care,” says J. Wesley Boyd, M.D., Ph.D., senior author of the study, an attending psychiatrist at Cambridge Health Alliance and an assistant clinical professor of psychiatry at Harvard Medical School.
The study, published online in October by Psychiatric Services, found that access to outpatient psychiatric services in Boston, Houston and Chicago was scarce even if the patient had private insurance or was willing to pay out of pocket.
“If you are a depressed patient and you think that because you have health insurance you are going to be able to get care when you need it, you are going have to make a lot of phone calls and get a lot of wrong numbers, full practices or just simply not even have your messages returned before you are going to get an appointment,” says Boyd.
Those willing to wade through numerous calls, wrong numbers and waiting for a call back from an office to get an appointment had to wait a month on average for that appointment, according to the study.
“We found it didn’t really matter what kind of insurance we had or how we were planning to pay for it, it was hard to get an appointment across the board,” says Monica Malowney, MPH, patient centered medical home manager for Maimonides Medical Center in Brooklyn, N.Y. and lead author of the study. “We found that only about one in four times will you get an appointment in these cities using our method and a lot of times that appointment will be pretty far away.”
Researchers simulated the patient experience by using a Blue Cross Blue Shield database to call 120 private psychiatrists in each city: Boston, Chicago and Houston. Researchers chose Blue Cross Blue Shield because it is the largest insurer in those three states, Malowney says. One third of callers said they had Blue Cross Blue Shield insurance, one third said they had Medicare and one third said they would pay out of pocket. Researchers found no significant differences in obtaining an appointment based on the method of payment.
In the first round of calling 360 psychiatrists, researchers were able to reach 119 (or 33 percent) of them, according to the study. The database had wrong numbers for 16 percent of psychiatrists called in the study. Of the 216 unanswered calls, 78 (or 36 percent) were returned.
In a second round of calls to 222 psychiatrists whom researchers were unable to reach in the first round, 75 calls (or 34 percent) were answered. Of the numbers listed correctly, researchers were able to speak with someone in 62 (or 28 percent) of calls. Of 123 unanswered calls in this round, 42 (or 34 percent) were returned.
In total, researchers were able to get appointment availability information for 219 of 360 psychiatrists. Of those, they were able to make appointments with 93 (or 26 percent) of psychiatrists.
Malowney says the research backs up what people are already experiencing in the real world.
“It’s a scary thought,” she says. “You imagine how many people there are that first come to the hard decision that they are going to seek treatment, and then when they do, they run into all these problems. So, really, what’s the likelihood that somebody is going to go through all these barriers?”
She says the study indicates a need for more mental health providers and better communication with patients on how to access services. Insurers also should provide accurate, up-to-date information, she says.
“Expanding health insurance coverage through the Affordable Care Act may thus do little to change the conditions that made it difficult for us to obtain outpatient appointments with psychiatrists – or worse, expansion of coverage might further overwhelm the capacity of available services from these providers,” the study states. It suggests that increasing the number of medical students that go into psychiatry would be helpful.
Researchers plan to do a similar study in the future with child psychiatrists.
By Rivkela Brodsky