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Comparative Study
. 2014 Feb;71(2):176-81.
doi: 10.1001/jamapsychiatry.2013.2862.

Acceptance of insurance by psychiatrists and the implications for access to mental health care

Tara F Bishop  1 , Matthew J Press  1 , Salomeh Keyhani  2 , Harold Alan Pincus  3
Affiliations
Comparative Study

Acceptance of insurance by psychiatrists and the implications for access to mental health care

Tara F Bishop et al. JAMA Psychiatry. 2014 Feb.

Abstract

Importance: There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance.

Objective: To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties.

Design, setting, and participants: We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not.

Main outcomes and measures: Our main outcome variables were physician acceptance of new patients with private noncapitated insurance, Medicare, or Medicaid. Our main independent variables were physician specialty and year groupings (2005-2006, 2007-2008, and 2009-2010).

Results: The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P < .001) and had declined by 17.0% since 2005-2006. Similarly, the percentage of psychiatrists who accepted Medicare in 2009-2010 was significantly lower than that for other physicians (54.8% [95% CI, 46.6%-62.7%] vs 86.1% [84.4%-87.7%]; P < .001) and had declined by 19.5% since 2005-2006. Psychiatrists' Medicaid acceptance rates in 2009-2010 were also lower than those for other physicians (43.1% [95% CI, 34.9%-51.7%] vs 73.0% [70.3%-75.5%]; P < .001) but had not declined significantly from 2005-2006. Psychiatrists in the Midwest were more likely to accept private noncapitated insurance (85.1%) than those in the Northeast (48.5%), South (43.0%), or West (57.8%) (P = .02).

Conclusions and relevance: Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

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Conflict of interest statement

The authors report no relevant conflicts of interest.

Figures

Figure 1
Figure 1
shows the percentage of office-based psychiatrists who accept various forms of insurance between the years 2005-2010. Figure 1a. Percentage of office-based physicians who accepted private non-capitated insurance, 2005–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year c p=0.01 for trend across years for psychiatrists, p<0.001 for trend across years for all other specialties Figure 1b. Percentage of office-based psychiatrists who accepted Medicare, 2005–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year and exclude pediatricians c p<0.001 for trend across years for psychiatrists, p=0.14 for trend across years for all other specialties Figure 1c. Percentage of office-based psychiatrists who accepted Medicaid, 2005–2010 a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year c p=0.29 for trend across years for psychiatrists, p=0.25 for trend across years for all other specialties
Figure 1
Figure 1
shows the percentage of office-based psychiatrists who accept various forms of insurance between the years 2005-2010. Figure 1a. Percentage of office-based physicians who accepted private non-capitated insurance, 2005–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year c p=0.01 for trend across years for psychiatrists, p<0.001 for trend across years for all other specialties Figure 1b. Percentage of office-based psychiatrists who accepted Medicare, 2005–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year and exclude pediatricians c p<0.001 for trend across years for psychiatrists, p=0.14 for trend across years for all other specialties Figure 1c. Percentage of office-based psychiatrists who accepted Medicaid, 2005–2010 a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year c p=0.29 for trend across years for psychiatrists, p=0.25 for trend across years for all other specialties
Figure 1
Figure 1
shows the percentage of office-based psychiatrists who accept various forms of insurance between the years 2005-2010. Figure 1a. Percentage of office-based physicians who accepted private non-capitated insurance, 2005–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year c p=0.01 for trend across years for psychiatrists, p<0.001 for trend across years for all other specialties Figure 1b. Percentage of office-based psychiatrists who accepted Medicare, 2005–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year and exclude pediatricians c p<0.001 for trend across years for psychiatrists, p=0.14 for trend across years for all other specialties Figure 1c. Percentage of office-based psychiatrists who accepted Medicaid, 2005–2010 a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year c p=0.29 for trend across years for psychiatrists, p=0.25 for trend across years for all other specialties
Figure 2
Figure 2
shows the percentage of office-based physicians who accept insurance by specialty type in 2009-2010. Percentage of office-based physicians who accepted insurance by specialty, 2009–2010a,b,c a survey-weighted percentages based on the sample that was surveyed b sample includes only physicians who accepted new patients in each study year. Medicare sample excludes pediatricians. c p<0.001 for comparison of psychiatrists and other specialties for all insurance types
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