The 2007 Connecticut Attorney General report on access to mental health care for children [PDF] was quite critical of the role that managed care had on shrinking access to mental health services for children and adolescents. Among the conclusions were:
The results of this survey, both the data collected and the written remarks of child and adolescent psychiatrists, show that countless children and adolescents are receiving inadequate psychiatric treatment, or no treatment at all. Although some patients may be adequately served by psychiatric care focused on the use of medication, a significant proportion of children and adolescents may need treatment that is more intensive, and more expensive, than therapy restricted to the use of drugs. Loss of access to this type of care, what psychiatrists call “relationship-based psychiatric care,” has been happening out of public sight.
One of the four recommended actions included:Using low reimbursement rates and bureaucratic hurdles to discourage the delivery of relationship-based care, managed care companies appear to be forcing many Connecticut child and adolescent psychiatrists out of managed care, making it increasingly difficult for many middle income children and adolescents to have adequate access to psychiatric care or to receive the relationship-based treatment that was formerly the standard of care. For many young people, the psychiatric care available appears to be either drugs, or nothing.
Plans must be required to canvas participating providers regularly to determine those providers who are actually available to see enrollees seeking to begin treatment. This information must be made easily available to enrollees so that they are not required to telephone their way through the provider list only to be told that participating psychiatrists are not participating after all, or are not seeing new patients.Unfortunately, it is common for payers to inflate the apparent size of their network by not keeping them accurate and up-to-date and including providers who no longer accept new patients or who do not take certain age groups or clinical problems. This report found that some payers had advertised networks that were 2, 3, and 4 times their actual effective size. (Is that fraud?)
Homework for the future: How many psychiatrists are in your network? How accurate is it?