Psychiatry is seeing many of the same challenges as other specialties
By: Cory Ellerd
Submitted: 2010-04-09 14:21:39 | Word Count: 809
Uneven Supply
Psychiatrists are not spread Across the country evenly. Nationwide, the psychiatrist per one hundred thousand inhabitants ratio stands at about 16.5 per 100,000. That statistic, which reaches its high in Massachusetts at 31.1 per .1 million, bottoms out at a little over four and a half per .1 million in Idaho. Counter-balancing the five states with the highest ratios Massachusetts, New York, PA, CA, and Texas are the five states with the lowest ratios: Idaho, Wyoming, South Dakota, North Dakota, and Alaska. The Western states have the lowest per capita supply.
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Health insurance
Adding to the problem are the vagaries of coverage providers practices and public health care systems. Some psychiatrists will only see patients with private insurance policies. Others, who are employed by regional behavioral health associations, may only give care for patients on the states Medicaid program. Arizona Health Care Cost Containment System will not see patients who have private insurance. And, there are some mental health doctors who will not accept any insurance plans.
Many private policies will only pay for a limited amount of mental health care. Mental health troubles are singled out by insurance policies, and subsequent care may not be approved despite persistent requirement. If a patient is still in need of coverage for depression, for example, but their plan only allows for no more than three mental care visits a year, they have no other options but to either discontinue care or pay for the care by themselves. This is a major concern for physicians in Arizona who deem that mental illnesses should be covered by insurers just like any other disease. For example, insurers in most cases will pay for as many outpatient visits and inpatient care needed to effectively manage a diabetic patient, but the same coverage provider will limit their coverage despite the need for subsequent care for patients who indeed have a mental health disturbance.
While some of the mental health requirements of patients can be managed by psychologists, some patients may be too ill and in need of an doctor who can prescribe medication, something a psychologist is not able to do. Over the years, doctors and mental health supporters have strongly lobbied for mental health parity that insurance companies treat mental illnesses like any other medical condition, thus leading to a greater availability of services for people with mental health problems.
Cost
The invisible costs of mental sickness is inestimable, but the monetary one is not. According to a report by the U.S. Surgeon General's office, in 1996 the United States spent more than ninety nine billion USD for the direct treatment of mental disorders. In 1990, the most recent time period for which estimates are available, the indirect cost of all mental illness was at seventy nine billion USD, with most of that amount coming from loss of productivity due to premature death, incarceration and time spent by family members caring for the ill.
Primary Care Alternative to Psychiatry
Primary care doctors are making an effort to compensate for the insurance abcess by learning how to care for such patients themselves. Because those primary care physicians know they are without anywhere to send such individuals, and the individual is going to keep coming back to them for care anyway, it behooves the doctors to expand their skills to cover these kinds of problems. However, many insurers refuse to reimburse primary care physicians for mental health services and only cover such services if provided by a psychiatrist.
Even with the health bill conclusively signed into law its effect on our health care is not established. By 2014 there will be an intensification in the enrollment into health care insurance programs. This build up when, combined with the long term aging of the populace, should push demand for services and therefore cost higher. However, no one yet knows what will happen to reimbursement rates from Medicaid and this new program. The question is will there be a cut of reimbursement levels for different specialties by Medicare and this new program that may conversely become a decreasing factor of the income of all specialties including Psychiatry, its related specialties, and subspecialties.
Clearly the Obama administration has its hands full. We are getting older and there are fewer young people to carry this growing financial burden. The Sins of the Fathers.....
Sources: The Centers for Disease Control and Prevention, School of Health Management and Policy at the W. P. Carey School of Business.
