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 Americans with health insurance were spending more out of pocket on
mental health services, such as treatment for substance abuse, than
on conditions like diabetes and heart failure, researchers found.
The reason: many were getting mental health care out of network,
according to a report published in JAMA Network Open.
"Consumers need to be better informed about the provider networks
they are signing up for," said study leader Wendy Xu, from the
division of health services management and policy in the College of
Public Health at The Ohio State University. "Sometimes they don't
know that their provider is not on the plan they are signed up for."
While the parity law mandates that co-pays and other costs be the
same whether care is for a physical or a mental ailment, it doesn't
dictate the number of mental health providers that need to be in a
network, Xu said. So it's possible that some plans "don't have
enough providers."
That would mean patients facing long waits might choose to go
outside the network for quicker access to care, Xu said, adding that
this is a topic for further study.
To take a closer look at the costs of mental health care among
people with private insurance coverage, Xu and her colleagues turned
to the Truven Health MarketScan Commercial Claims and Encounters
Database, a nationwide claims database that includes detailed
information on treatment episodes, such as detailed diagnoses,
procedures and care settings. The database also includes information
on whether the clinicians and facilities were in the patient's
insurance network and contain actual reimbursement based on network
status.
Focusing on data from 2012-2017, the researchers identified 3.2
million adults with mental health conditions, 294,550 with alcohol
use disorders, 321,535 with drug use disorders, 178,701 with heart
failure and nearly 1.4 million with diabetes with coverage under
employer-sponsored insurance plans.
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Patients with behavioral health conditions were more likely than
those with physical health problems to end up seeing out-of-network
physicians. For example, those with drug use disorders were 12.9
percentage points more likely to receive out of network inpatient
care than those with chronic heart failure and 15.3 percentage
points more likely to receive out of network outpatient care.
Costs were also higher for those with behavioral health issues. On
average, individuals with mental health conditions ended up paying
$341 more than those with diabetes. Those with drug use disorders
ended up paying $1,242 more than those with diabetes.
The findings did not surprise Dr. Albert Wu, an internist and
professor of health policy and management at the Johns Hopkins
Bloomberg School of Public Health
"This paper validates things I experience in my practice every day
and that my patients complain about," Wu said. "People with
behavioral health problems bear a really heavy burden of healthcare
costs and this is true even for privately insured adults."
Part of the problem may be a shortage of mental health
professionals, Wu said. "It difficult even for a physician caring
for insured patients to find a trusted provider who has availability
of appointments in a timely manner," he said. "Those providers who
are available are always full, but more than that, perhaps, the
majority of these physicians decline to participate in plans because
the payments are too low. Many don't even accept private insurance
and simply ask people to pay out of pocket.
Things might improve if reimbursement rates went up, Wu said. "These
specialties are the least well paying," he added.
SOURCE: http://bit.ly/34HCUE3 JAMA Network Open, online November 6,
2019.
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