Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
Department of Population Health, New York University School of Medicine, New York.
JAMA Netw Open. 2021 Oct 1;4(10):e2130770. doi: 10.1001/jamanetworkopen.2021.30770.
Ten years after the Mental Health Parity and Addiction Equity Act, patients continue to report insurance-related barriers to specialty mental health care.
To assess privately insured patients' perceptions of the adequacy of their health plan's provider network (provider network includes physicians, clinicians, other health care professionals, and their institutions that constitute the network), whether practitioners frequently leave plans, and whether practitioner plan participation affected patients' plan choice.
DESIGN, SETTING, AND PARTICIPANTS: A nationally representative, population-based internet survey study of English-speaking US adults participating in KnowledgePanel, an online research panel, was conducted from August to September 2018. Data analysis was performed from November 12, 2020, to May 12, 2021. From a sample of 29 854 panelists aged 18 to 64 years, 19 602 initiated the screener (completion rate of 66%), and 728 met study criteria: adults with private insurance receiving both specialty mental health and medical care in the past year.
Health plan's provider network.
Self-report of plan inadequacy, whether a practitioner left the plan and the participant's responses (stopped treatment, switched practitioner, or continued treatment), and whether participation of a specific practitioner was considered when a health plan was chosen. Experiences with both mental health and medical provider networks were assessed. Analyses were weighted to match the sample to the US population. Weights provided by KnowledgePanel were also adjusted for panel recruitment, attrition, oversampling, and survey nonresponse.
Of a total of 728 study participants, 204 (39%) were aged 18 to 34 years, 504 (61%) were women, 82 (17%) were Hispanic, and 551 (66%) were non-Hispanic White individuals. Serious psychological distress was reported by 262 participants (36%), and 214 participants (29%) also received mental health treatment from a primary care practitioner. Participants rated their mental health provider network as inadequate more frequently than their medical provider network (163 [21%] vs 70 [10%]; odds ratio [OR], 2.69; 95% CI, 1.64-4.40; P < .001). However, among the 193 participants also receiving mental health treatment from a primary care practitioner, there was no significant difference in the ratings of mental health and medical provider networks (44 [14%] vs 18 [9%]; OR, 1.55; 95% CI, 0.65-3.67; P = .32). Sixty participants (8%) reported that a mental health practitioner had left their plan's insurance network in the past 3 years. Of the 523 participants with a choice of plan, 98 (20%) considered whether a specific mental health practitioner was in network before choosing a plan.
This study's findings suggest that more participants perceived their mental health networks to be inadequate compared with their medical networks. Increasing the availability of mental health treatment in primary care practices may aid plans in constructing adequate mental health provider networks and improve patient access to mental health care.
在《精神健康和平等与成瘾权益法案》颁布 10 年后，患者仍然报告保险相关的专业精神保健障碍。
评估私人保险患者对其健康计划提供网络的充足性的看法（提供网络包括构成网络的医生、临床医生、其他卫生保健专业人员及其机构）、从业者是否经常离开计划，以及从业者的计划参与是否影响患者的计划选择。
设计、地点和参与者：这是一项全国性的、基于人群的、针对参加 KnowledgePanel 的英语美国成年人的互联网调查研究，KnowledgePanel 是一个在线研究小组，从 2018 年 8 月至 9 月进行。数据分析于 2020 年 11 月 12 日至 2021 年 5 月 12 日进行。从 29854 名年龄在 18 至 64 岁的小组参与者中，有 19602 名启动了筛选器（完成率为 66%），有 728 名符合研究标准：过去一年接受私人保险并接受专科精神保健和医疗服务的成年人。
健康计划的提供网络。
计划不足的自我报告、从业者是否离开计划以及参与者的反应（停止治疗、更换从业者或继续治疗），以及在选择健康计划时是否考虑了特定从业者的参与。评估了心理健康和医疗提供网络的经验。分析加权以匹配样本与美国人口。KnowledgePanel 提供的权重还针对小组招募、人员流失、过采样和调查无应答进行了调整。
在总共 728 名研究参与者中，有 204 名（39%）年龄在 18 至 34 岁，504 名（61%）为女性，82 名（17%）为西班牙裔，551 名（66%）为非西班牙裔白人。有 262 名参与者（36%）报告有严重的心理困扰，214 名参与者（29%）也接受过初级保健从业者的心理健康治疗。参与者对其心理健康提供者网络的评价不如对其医疗提供者网络的评价那么不足（163 [21%] 对 70 [10%]；比值比[OR]，2.69；95%置信区间[CI]，1.64-4.40；P<0.001）。然而，在接受初级保健从业者心理健康治疗的 193 名参与者中，心理健康和医疗提供者网络的评分没有显著差异（44 [14%] 对 18 [9%]；OR，1.55；95% CI，0.65-3.67；P=0.32）。有 60 名（8%）参与者报告说，过去 3 年内，心理健康从业者已经离开他们计划的保险网络。在有计划选择的 523 名参与者中，有 98 名（20%）在选择计划之前考虑了特定的心理健康从业者是否在网络中。
这项研究的结果表明，与医疗网络相比，更多的参与者认为他们的心理健康网络不足。增加初级保健实践中精神健康治疗的可及性可能有助于计划构建足够的精神健康提供者网络，并改善患者获得精神保健的机会。
