Factors that Affect Choice of Mental Health Provider and Receipt of Outpatient Mental Health Treatment

Abstract

According to the US Department of Health and Human Services, 91 million adults live in mental health professional shortage areas and 10 million individuals have serious mental illness (SMI). This study examines how the supply of psychiatrists, severity of mental illness, out-of-pocket costs, and health insurance type influence patients' decisions to receive treatment and the type of provider chosen. Analyses using 2012-2013 MarketScan Commercial Claims data showed that patients residing in an area with few psychiatrists per capita had a higher predicted probability of not receiving follow-up care (46.4%) compared with patients residing in an area with more psychiatrists per capita (42.5%), and those in low-psychiatrist-supply areas had a higher predicted probability of receiving prescription medication only (10.2 vs 7.6%). Patients with SMI were more likely than those without SMI to obtain treatment. A $25 increase in out-of-pocket costs had marginal impact on patients' treatment choices.

Impact of Mental Health Treatment on Suicide Attempts

“…Denser areas of mental health providers area associated with higher levels of follow-up care and lower rates of prescription only treatment. 21 Consistent with the results of this study, timely and recurring visits with mental health providers can improve care coordination with other providers 24 and is associated with other positive behavioral health outcomes. 25,26 However, it should be noted that insurance coverage, out-of-pocket costs, and limited mental health service provider participation in insurance plans can be important barriers to accessing mental health treatment, 27 and thus, an increase in provider concentration might not necessarily translate into more utilization of treatment.…”

“…The AHRF provides the number of psychologists and psychiatrists for each county in the USA. The number of mental health professionals can affect the access and travel costs for mental health care 21 and thus should be associated with patient propensity to receive mental health treatment. Though mental health providers may be driven to locate in areas by factors that are associated with suicide, namely, income levels, and urbanity, when conditioning on these other factors, an instrumental variable approach can still identify the effect of the mental health treatment.…”