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FOR IMMEDIATE RELEASE, May 10, 2017
Contact: Clare Fauke, communications specialist, PNHP, 312-782-6006 or clare@pnhp.org
J.Wesley Boyd, M.D., Cambridge Health Alliance, 617-833-1840 or jwboyd@cha.harvard.edu

A new study published in the International Journal of Health Services  found that access to outpatient mental health care for children—whether with a child psychiatrist or a pediatrician—is very limited, even for those with private insurance or the ability to pay out of pocket for care. Almost one-fifth of children and adolescents in the United States suffer from a serious mental disorder, but fewer than half of those needing care receive treatment. Researchers found several roadblocks to obtaining timely care, including longer wait times for psychiatric appointments versus pediatric appointments, a lack of providers accepting Medicaid patients and incorrect contact information provided by the insurer.

The study attempted to replicate the experience of a parent trying to obtain needed psychiatric care for a child. Using the Blue Cross Blue Shield (BCBS) online database of in-network providers, the authors called child psychiatrists and pediatricians in the Boston, Seattle, Minneapolis, Chapel Hill, and Houston metropolitan areas. Researchers called the offices of 601 pediatricians and 312 child psychiatrists claiming to be the parent of a 12-year-old child with depression seeking the earliest possible appointment. The authors altered their proposed method of payment, randomly stating either that they 1) carried BCBS PPO insurance, 2) carried Medicaid, or 3) were willing to pay out of pocket for care.

The roadblocks to care include the following:

• Longer wait times for psychiatry appointments: Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Appointments were obtained with 40% of pediatricians but only 17% of child psychiatrists; the mean wait time for psychiatry appointments was 30 days longer than for pediatrics. Research has shown that long wait times for mental health appointments can negatively impact a person’s engagement in care.
• Limited access for children on Medicaid: Callers were less likely to obtain appointments for children on Medicaid (22%) than for those with private insurance (37%) or the ability to pay out-of-pocket (37%). Measures to increase physicians acceptance of public insurance, such as higher physician reimbursement and decreased administrative paperwork, may help improve access for patients with Medicaid.
• Incorrect contact information listed by insurer: One of the most common barriers to making appointments was incorrect or outdated provider information listed on the BCBS site, suggesting that insurance companies may not be vigilant about maintaining accurate databases. “Given how difficult it can be for parents to obtain needed mental health care for their children, insurance companies need to ensure that their provider lists contain accurate information and are as user-friendly as possible,” said lead author Shireen Cama, M.D., a child psychiatry fellow at Cambridge Health Alliance and Harvard Medical School.

Analysis: Private insurers lack incentive for improving access to care

Senior author J. Wesley Boyd, M.D., Ph.D., an attending psychiatrist at Cambridge Health Alliance and faculty member in psychiatry and in the Center for Bioethics at Harvard Medical School, observed that under America’s fragmented, for-profit health insurance system, private insurers do not have an incentive to ensure better access to care. “We found that rosters of health professionals provided by insurance companies often include providers who have either left a practice location, are no longer accepting new patients, or simply aren’t listed with a correct phone number,” said Dr. Boyd. “Insurance companies profit when their enrollees are unable to access care, and patients suffer as a result. We need to take the profit motive out of health care and adopt a single payer, Medicare for all system that guarantees care for patients, not profits for insurers.”

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“Availability of outpatient mental health care by pediatricians and child psychiatrists in five U.S. cities,” Shireen Cama, M.D., Monica Malowney, M.P.H., Anna Jo Bodurtha Smith, M.D., M.P.H., Margaret Spottswood, M.D., M.P.H., Elisa Cheng, M.D., Louis Ostrowsky, M.D., Jose Rengifo, M.D., J. Wesley Boyd, M.D., Ph.D. International Journal of Health Services, May 9, 2017. A copy of the full study is available to media professionals upon request from Clare Fauke, clare@pnhp.org or 312-782-6006.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and educational organization of more than 21,000 doctors who support a single-payer national health program. PNHP had no role in funding or otherwise supporting the studies or commentary described above.

FOR IMMEDIATE RELEASE, February 21, 2017
Contact: Mark Almberg, PNHP communications director, 312-782-6006, mark@pnhp.org

Proposals floated by Republican leaders won’t achieve President Trump’s campaign promises of more coverage, better benefits, and lower costs, but a single-payer reform would, according to a commentary published today [Tuesday, Feb. 21] in Annals of Internal Medicine, one of the nation’s most prestigious and widely cited medical journals.

Republicans promised to repeal the Affordable Care Act on the first day of the Trump presidency. But the health reform effort has stalled because Republicans in Congress have been unable to come up with a better replacement and fear a backlash against plans that would deprive millions of coverage and raise deductibles.

In today’s Annals commentary, longtime health policy experts Drs. Steffie Woolhandler and David Himmelstein warn that the proposals by Speaker Paul Ryan, R-Wis., and Secretary of HHS Tom Price would slash Medicaid spending for the poor, shift the ACA’s subsidies from the near-poor to wealthier Americans, and replace Medicare with a voucher program, even as they would cut Medicare’s funding and raise the program’s eligibility age.

Woolhandler and Himmelstein review evidence that, in contrast, single-payer reform could provide comprehensive first-dollar coverage to all Americans within the current budgetary envelope because of vast savings on health care bureaucracy and profits. The authors estimate that a streamlined, publicly financed single-payer program would save $504 billion annually on health care paperwork and profits, including $220 billion on insurance overhead, $150 billion in hospital billing and administration and $75 billion doctors’ billing and paperwork. They estimate that an additional $113 billion could be saved each year by hard bargaining with drug companies over prices. A table in the paper summarizes these savings.

The savings would cover the cost of expanding insurance to the 26 million who remain uninsured despite the ACA, as well as “plugging the gaps in existing coverage – abolishing copayments and deductibles, covering such services as dental and long-term care that many policies exclude.”

The lead author of the commentary, Dr. Steffie Woolhandler, is an internist, distinguished professor of public health and health policy at CUNY’s Hunter College, and lecturer in medicine at Harvard Medical School. She said: “We’re wasting hundreds of billions of health care dollars on insurance paperwork and profits. Private insurers take more than 12 cents of every premium dollar for their overhead and profit, as compared to just over 2 cents in Medicare. Meanwhile, 26 million are still uninsured and millions more with coverage can’t afford care. It’s time we make our health care system cater to patients instead of bending over backward to help insurance companies.”

Dr. David Himmelstein, the senior author, is a primary care doctor and, like Woolhander, a distinguished professor at CUNY’s Hunter College and lecturer at Harvard Medical School. He noted: “We urgently need reform that moves forward from the ACA, but the Price and Ryan plans would replace Obamacare with something much worse. Polls show that most Americans – including most people who want the ACA repealed, and even a strong minority of Republicans – want single-payer reform. And doctors are crying out for such reform. The Annals of Internal Medicine is one of the most respected and traditional medical journals. Their willingness to publish a call for single payer signals that it’s a mainstream idea in our profession.”

The Annals of Internal Medicine is the flagship journal of the American College of Physicians (ACP), the nation’s largest medical specialty organization with 148,000 internal medicine physicians (internists), related subspecialists, and medical students. In 2007, the Annals published a lengthy policy article in which the ACP said a single-payer system was one pathway to achieving universal coverage. In early 2008, the journal published a study showing 59 percent of U.S. physicians support “government legislation to establish national health insurance,” a leap of 10 percentage points from five years before.

Today’s commentary is believed to be the first full-length call for single payer, or national health insurance, that the journal has published in its 90-year history.

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“Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs,” by Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. Annals of Internal Medicine. Published online first, Feb. 21, 2017. doi:10.7326/M17-0302.

A copy of the full article is available to media professionals upon request from Mark Almberg, communications director, mark@pnhp.org, (312) 782-6006.

Disclosures: Drs. Woolhandler and Himmelstein co-founded Physicians for a National Health Program (www.pnhp.org), a nonprofit educational and research organization that supports a single-payer national health plan; they also served as advisers to Sen. Bernie Sanders’ presidential campaign. Neither the Sanders campaign nor PNHP played any role in funding or otherwise supporting the commentary.