Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care
Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care
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DOI：
10.1001/jamapsychiatry.2013.2862
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发表时间：
2014-02-01
期刊：
影响因子：
25.8
通讯作者：
Pincus, Harold Alan
中科院分区：
文献类型：
--
作者：
Bishop, Tara F.;Press, Matthew J.;Pincus, Harold Alan
重要性：最近有人呼吁增加获得精神卫生服务的机会，但由于精神科医生拒绝接受保险，这种机会可能受到限制。目的描述精神病医生与其他专科医生相比接受保险的最新趋势。设计、环境和参与者我们使用来自美国全国办公室医生调查的数据来计算精神科医生与其他专业医生接受私人非资本保险、医疗保险和医疗补助的比率，并比较接受保险和不接受保险的精神科医生的特征。主要结果和测量我们的主要结果变量是医生接受新患者的私人非资本保险、医疗保险或医疗补助。我们的主要独立变量是医生专业和年份分组（2005-2006年、2007-2008年和2009-2010年）。结果2009-2010年接受私人非资本保险的精神科医师比例显著低于其他专科医师比例（55.3%[95% CI, 46.7% ~ 63.8%] vs 88.7%[86.4% ~ 90.7%], P < 0.001）， 2005-2006年以来下降了17.0%。同样，2009-2010年接受医疗保险的精神病医生比例明显低于其他医生（54.8%[95% CI, 46.6%-62.7%] vs 86.1% [84.4%-87.7%]; P < .001），自2005-2006年以来下降了19.5%。2009-2010年精神科医生的医疗补助接受率也低于其他医生（43.1% [95% CI, 34.9%-51.7%] vs 73.0% [70.3%-75.5%]; P < .001），但2005-2006年没有显著下降。中西部精神病医生接受私人非资本保险的比例（85.1%）高于东北部（48.5%）、南部（43.0%）和西部（57.8%）（P = .02）。结论和相关性精神科医生对各类保险的接受率明显低于其他专科的内科医生。这种低接受率可能对获得精神卫生服务构成障碍。
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.