(Reuters Health) – Many Americans go insured from the network for mental health services, a new study suggests, despite the higher costs for them and despite federal law that prescribes mental health policies as well as their physical health envelope.
Americans with health insurance were spending more of a pocket on mental health services, such as treatment for substance misuse, than on conditions such as diabetes and heart failure, researchers found. Reason: many people were receiving mental health care from a network, according to a report published in JAMA Network Open.
“Consumers need to be better informed about the networks of providers they are registering for,” said study leader Wendy Xu, from a number of health services management and policies at the College of Public Health at Ohio State University. “Sometimes they don't know that their supplier is not on the plan for which they are registered.”
While the parity laws mandate that co-payment and other costs are the same whether care is for physical or mental illness, it does not represent the number of mental health providers that must be in a network, Xu said. So many providers may not have some plans. "
This would mean that patients waiting for long visits may choose to go outside the network to get faster access to care, said Xu, adding that this is a matter for further study.
To look more closely at the costs of mental health care among people with private insurance cover, Xu and his colleagues met the HealthScan MarketScan Truven's Certain Claims and Commercial Database, a national claims database that includes detailed information about treatment incidents, for example. diagnoses, procedures and care settings. The database also includes information on whether clinicians and facilities were in the patient's insurance network and whether actual reimbursement is based on network status.
Focusing on data from 2012-2017, researchers identified 3.2 million adults with mental health conditions, 294,550 alcohol use disorders, 321,535 drug use disorders, 178,701 with heart failure and almost 1.4 million with diabetes covered by plans. insurance is sponsored by employers.
Patients with behavioral health conditions were more likely to find physicians outside the network looking at off-network physicians. For example, people with drug use disorders were 12.9 percentage points most likely to receive network outpatient care than those with chronic heart failure and 15.3 percentage points most likely to receive out-patient network care.
There were also higher costs for those with health problems. On average, individuals with mental health conditions paid $ 341 more than those with diabetes. The people with drug use disorders paid them $ 1,242 more than those with diabetes.
The results were not surprising. Albert Wu, an intern and professor of health policy and management at Johns Hopkins Public Health School Bloomberg
“This paper validates what I have experienced in my practice every day and that my patients complain about it,” said Wu. “People with behavioral health problems face a heavy burden on healthcare costs and this is true for privately insured adults.” T
There may be a shortage of mental health professionals as part of the problem, Wu said. “It is even difficult for your doctor taking care of insured patients to find a reliable supplier who has access to appointments in a timely manner,” he said. “Those providers are always available full, but more than that, perhaps, most of these physicians refuse to participate in plans because the payments are too low. Even private insurance is not acceptable and only asks people to pay for a pocket.
Things could be improved if repayment rates came up, Wu said. “These specialties are the least they pay,” he said.
SOURCE: bit.ly/34HCUE3 JAMA Network Open, online November 6, 2019.
. t) Managed Healthcare (TRBC) (t) Health Care (TBC) (t) Psychology (t) United States of America