Nicole M. Benson is an instructor in psychiatry at Harvard Medical School, in Boston, Massachusetts, and a psychiatrist at Massachusetts General Hospital and McLean Hospital, in Belmont, Massachusetts.
Zirui Song (
Health Aff (Millwood). 2020 Jul;39(7):1210-1218. doi: 10.1377/hlthaff.2019.01468.
Patients in the US are more likely to receive out-of-network behavioral health care, including treatment for mental health or substance use disorders, than they are to receive other medical and surgical services out of network. To date, out-of-network and in-network trends in the prices and use of ambulatory behavioral health care have been seldom described. Here we compare levels and growth of insurer-negotiated prices (allowed amounts), patient cost sharing, and use of psychotherapy services in network and out of network in a large, commercially insured US population during 2007-17. For both adult and child psychotherapy, prices and cost sharing were substantially higher out of network than they were in network. These gaps widened during the eleven-year period. Prices and cost sharing for in-network psychotherapy decreased during this period, whereas prices and cost sharing for out-of-network psychotherapy increased. Use of adult and child psychotherapy increased during this period, driven by growth of in-network rather than out-of-network use. The increasing gap in prices and cost sharing between out-of-network and in-network psychotherapy, viewed in the context of a shortage of behavioral health providers who accept insurance, may limit access to ambulatory behavioral health care.
美国的患者更有可能获得非联网的行为健康护理，包括心理健康或药物使用障碍的治疗，而不是接受其他非联网的医疗和外科服务。迄今为止，关于非联网和联网的门诊行为健康护理的价格和使用趋势很少有描述。在这里，我们在 2007 年至 2017 年期间，比较了大量商业保险的美国人群中，联网和非联网的保险公司协商价格（允许金额）、患者自付费用和心理治疗服务使用的水平和增长情况。对于成人和儿童的心理治疗，非联网的价格和自付费用都远远高于联网。在这十一年期间，这些差距不断扩大。在此期间，联网心理治疗的价格和自付费用下降，而非联网心理治疗的价格和自付费用上升。在此期间，成人和儿童心理治疗的使用量增加，这是由联网治疗而非非联网治疗的增长推动的。在保险接受者短缺的背景下，非联网和联网心理治疗之间的价格和自付费用差距不断扩大，可能会限制对门诊行为健康护理的获得。
