Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch, Ndumele, Loveridge); Department of Population Health, New York University School of Medicine, New York (Kyanko).
Psychiatr Serv. 2019 Jan 1;70(1):35-39. doi: 10.1176/appi.ps.201800014. Epub 2018 Nov 20.
Privately insured individuals frequently use out-of-network psychiatrists. Yet, whether treatment provided by psychiatrists who do not accept private insurance differs from treatment provided by those who do has not been studied. The investigators described provider characteristics, patient characteristics, and treatment patterns among psychiatrists who do not accept new patients with private insurance.
Data for this study came from the National Ambulatory Medical Care Survey (2011-2014), a nationally representative annual cross-sectional survey of physicians providing ambulatory care. Responses of psychiatrists who report accepting any new patients (N=440) were examined, representing 7,634 visits.
Compared with psychiatrists accepting privately insured patients, those not accepting privately insured patients had fewer visits with patients with serious mental illness (42% versus 53%; p=0.016). These psychiatrists had a higher proportion of visits lasting longer than 30 minutes (48% versus 34%; p=0.026), and their patients were more likely to have had 10 or more visits in the past 12 months (41% versus 28%; p=0.013). There were no differences in the proportion of visits in which treatment included psychotherapy (48% versus 44%).
Although psychiatrists not accepting patients with private insurance were less likely than other psychiatrists to treat patients with serious mental illness, their patients were more likely to have longer visits and a relatively high number of visits in the past year. The low rate of acceptance of insurance among psychiatrists may have the greatest effect among those most in need of services.
私人保险的个人经常使用网络外的精神科医生。然而，尚未研究不接受私人保险的精神科医生提供的治疗与接受私人保险的精神科医生提供的治疗是否存在差异。研究人员描述了不接受新私人保险患者的精神科医生的提供者特征、患者特征和治疗模式。
本研究的数据来自全国门诊医疗保健调查（2011-2014 年），这是一项针对提供门诊护理的医生的全国代表性年度横断面调查。对报告接受任何新患者（N=440）的精神科医生的反应进行了检查，代表了 7634 次就诊。
与接受私人保险患者的精神科医生相比，不接受私人保险患者的精神科医生治疗严重精神疾病患者的就诊次数较少（42%比 53%；p=0.016）。这些精神科医生的就诊时间超过 30 分钟的比例更高（48%比 34%；p=0.026），并且他们的患者在过去 12 个月中就诊次数更可能达到 10 次或更多（41%比 28%；p=0.013）。治疗中包括心理治疗的就诊比例没有差异（48%比 44%）。
尽管不接受私人保险患者的精神科医生治疗严重精神疾病患者的可能性低于其他精神科医生，但他们的患者更有可能进行较长时间的就诊，并且在过去一年中就诊次数相对较高。精神科医生接受保险的低比例可能对最需要服务的人影响最大。
