Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Overhage, Flores, Cook); M.D.-Ph.D. Program (Overhage) and Department of Psychiatry (Benson, Flores, Cook), Harvard Medical School, Boston; Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts (Benson).
Psychiatr Serv. 2024 Sep 1;75(9):833-838. doi: 10.1176/appi.ps.20230524. Epub 2024 Apr 10.
Many parents struggle to find mental health care for their children, and many mental health clinicians do not accept insurance payments. The authors aimed to estimate the frequency and cost of self-pay psychotherapy and psychotropic medication management visits for youths and to determine how service use varies by family income.
A descriptive cross-sectional analysis was performed among youths ages 5-17 years in the 2018-2020 Medical Expenditure Panel Survey. Specialist visits included those with psychiatrists, psychologists, social workers, and mental health counselors or family therapists.
Approximately one in five of 13,639 outpatient mental health specialist visits were self-pay, with psychologists (23% of visits) and social workers (24% of visits) most likely to see youths on a self-pay basis. Use of self-pay care was strongly associated with higher income, but even families earning <$28,000 per year utilized some self-pay care, at a median cost of $95 per visit. Self-pay visits were associated with slightly lower clinical need than insurance-covered visits, although this measure varied by income.
The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families.
许多父母难以为子女找到心理健康护理，许多心理健康临床医生也不接受保险支付。作者旨在估计青少年自付心理治疗和精神药物管理就诊的频率和费用，并确定服务使用如何因家庭收入而异。
对 2018-2020 年医疗支出面板调查中 5-17 岁的青少年进行描述性横断面分析。专科就诊包括精神病医生、心理学家、社会工作者以及心理健康顾问或家庭治疗师。
约有 13639 次门诊心理健康专家就诊中有五分之一是自费的，其中心理学家（占就诊的 23%）和社会工作者（占就诊的 24%）最有可能为青少年提供自费服务。自费护理的使用与较高的收入密切相关，但即使是年收入低于 28000 美元的家庭也会使用一些自费护理，每次就诊的中位数费用为 95 美元。自费就诊与保险覆盖就诊相比，临床需求略低，但这一衡量标准因收入而异。
儿童心理健康护理的自费市场可能会使低收入家庭负担更高的费用，从而加剧获得护理的不平等。例如，通过提高报销率和减少文书工作，鼓励心理健康提供者为其更大比例的患者群体参加保险，可能有助于改善心理健康护理的公平获得。就报销率而言，接受保险的自费心理健康就诊的频率表明，与患者和家庭的受益相比，心理健康服务的报销不足。
