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Opposing Arguments
LeeAnn Boore
College of Public, Health George Mason University
HAP 465: Integration of Professional Skills and Issues
Professor Kimberly Brathwaite
October 15th, 2023
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Opposing Arguments
Experiences with Care Providers and Insurance Plans
Negative experiences with care providers or insurance plans can make for troubled treatment
plans. Patients living with mental illness have a significantly higher rates of problems with
providers and insurance plans compared to people without a mental illness. According to Rowan
and Shippee published through the American Psychiatric Association, around Thirty-nine percent
of patients living with persistent mental illness report problems with treatment approvals, thirty
six percent report having problems with customer service and around thirty three percent report
having problems with finding the needed information (2015). Over the past decade or two, there
has been a decline in psychotherapy and an increase in the use of prescriptions.
Combination therapy is recommended by physicians and preferred by patients, but this
could have contributed to certain regulations being put into place that affect the experiences had
from patients living with mental health conditions. There are several reasons why patients living
with mental illness have a higher rate of difficulties when interacting with health care providers
and insurance plans. These difficulties and adverse experiences discourage people suffering with
mental illness from seeking care, can jeopardize access, maintenance of care, or can increase the
severity of the illness or symptoms due to the illness (Rowan and Shippee, 2015).
Coverage from insurance providers for behavioral or mental health is forever changing.
These constant changes can make it especially difficult for people living with mental health
conditions or behavioral health conditions to receive care covered by insurance or understand
what type of care and for how long that care will be covered by insurance. A large majority of
patients with insurance have some sort of coverage for mental health conditions. Although most
private plans offer some coverage, government insurances have coverage limits that are
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substantial compared to treatment of physical illness (Rowan and Shippee, 2015). A large
amount of the population is uninsured, and they experience no coverage for any care received.
Due to the lack of coverage or limit to coverage, if any coverage is received from the patient they
will expierence severe economic hardship as an individual and their families, or the public
system ends up having to cover the cost.
Barriers to Mental Health Care
There are barriers associated with access to care and treatment of mental health issues.
For many of the population in the United States treatment remain far out of reach. According to
the Association of American Medical Colleges, more than 52.9 million US adults which is
twenty one percent of the population has a mental health condition (2022). Within this large
number of adults living with mental health conditions individuals with insurance face many
barriers including lack of available providers, geographically poor access to care, inadaptation
insurance coverage, high out of pocket costs and fragmented care (Modi, 2022). The COVID-19
pandemic has only heightened mental health problems for all ages.
As a country the United States in is need of mental health professionals. Stated by
Hemangi Modi, analysts, with the Association for American Medical Colleges and colleagues
“Less than one-third of the U.S. population (28%) lives in an area where there are enough
psychiatrists and other mental health professionals available to meet the needs of the population
— in fact, most states have fewer than 40% of the mental health professionals needed.” (para.4).
This shortage and poor distribution of needed mental health professionals continues to impede
proper access to care. There are not enough mental health professionals nor resources to aid the
treatment of the rising mental health conditions.
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Finding a geographically accessible provider is another huddle for mental health patients.
Even if you can find a provider that is accessible, it can be difficult to find a provider within
one’s insurance network and a patient. In result, the patient ends up paying high out of pocket
costs for the out of network care received or the patient refuses to seek the needed care. There is
a growing number of mental health professionals that are not accepting insurance. There was a
study in 2014 that found that there was only fifty-five percent of psychiatrists that accepted
private insurance. Compared to 2009 and 2010, eighty-nine percent of physicists accepted
private insurance (Modi et al., 2022). The main reason for this disparity is that are very low
reimbursement rates for mental health services. The reimbursement rates can hover anywhere
between six and twenty eight percent.
There has to be a large range on short- and long-term policies created to ensure the
prioritizing of mental health patients the needed care by growing the workforce, expanding
insurance coverage for patients, increasing reimbursement rates for providers and enforcing state
and national laws (Modi et, at, 2022). These needed policies will stretch the already burnout
healthcare system too thin to be successful.
Challenges in the delivery of Behavioral health care
Social consequences of mental health and substance abuse problems, high direct costs of
treatment, development of private sector and quality protection challenges. According to the
National Library of Medicine, since mental health conditions in societies prevalence is high there
is a substantial economic burden. Behavioral health is diverse, highly competitive and new;
therefore, it is not intensely regulated compared to the more traditional ways of managed care
(National Library of Medicine). Due to these characteristics, there are challenges associated with
delivery of Behavioral Health care.
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Within private and public healthcare systems cost shifting can be a consequence of
financial arrangements. Cost shifting is when the cost of caring for untreated problems is shifted
or moved to another service system (National Library of Medicine). This can lead to the
increased use of emergency rooms and increased incarcerated individuals.
There has been a steady increase in the private sector of behavioral health care after
World War II. According to The National Library of Medicine this division of public and private
sectors made the treatment costs inconsistent, fragmented and contributes to consumers living a
lifetime of public care and unemployment (1997). Even though the rise of the private sector
helped to manage some aspects of behavioral health this sector involved lack of expierence
associated with managing comprehensive treatment and lack of expierence with supporting the
more disabled population, covering only portions of care and high increases in rates due to large
companies dominating the market (Edmunds et al., 1997).
Competition in the healthcare market is supposed to drive prices down and quality up.
Instead, competition involves adaptation, innovation and rapid developments of new approaches
and products (Edmunds et al, 1997). This competition raises the challenges for quality assurance
and accreditation meaning that treatment options for mental health conditions are becoming more
abundant. The quality assurance measurement assessments is not complex or continuing to
evolve to provide safety requirements needed for proper care.
These revolving problems surrounding experiences with care providers and insurance
plans, barriers to mental health care and challenges in the delivery of behavioral health care
statewide plans could offer an increase concern for the overall treatment of mental health
conditions, illnesses, and disorders.
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References
Challenges in delivery of behavioral healthcare. (1997). In Edmunds M, Frank R, Hogan M,
McCarty, D. Managing Managed Care: Quality Improvement in Behavioral Health.
National Academic Press.
Modi, H., Orgera, K., & Grover, A. (2022, October 10). Exploring barriers to mental health care
in the U.S. Association of American Medical Colleges. https://www.aamc.org/advocacypolicy/aamc-research-and-action-institute/barriers-mental-health-care
Rowan, K. & Shippee, N. D. (2015). Experiences With Insurance Plans and Providers Among
Persons with Mental Illness. Psychiatric Services (Washington, D.C.), 67(3), 282–288.
https://doi.org/10.1176/appi.ps.201400514
Peer Review of Assignment 5: Opposing Arguments
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Item
Write a brief narrative (23 sentences) that outlines
your first impression of
this section of the paper.
Indicate what you LIKE
about the writing
(positive/encouraging
feedback).
Does reading this section
of the paper make you
more curious to read
about the supporting
arguments? Why or why
not?
Is there a clear
connection regarding how
these arguments counter
the paper’s thesis?
Are there parts of the
arguments that are
confusing? Where would
you like more details or
examples to help you see
what the author means?
What parts could use
more explanation or
definitions?
How clear is the writing?
If there are places that
seem wordy or unclear,
how might the author
revise to address those
problems?
Are in-text citations
formatted correctly and
used often enough? Is
each Argument Labeled
correctly, using Level 1
and Level 2 headings?
Overall Comments:
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