As the Affordable Care Act continues to roll out, a recent study has uncovered what could be a major barrier to wider mental health care in the United States: psychiatrists are considerably less likely than other doctors to accept insurance. This means that in order to see one, you may need some deep pockets.

The study only polled psychiatrists — medical doctors with specialized training in mental disorders. Other types of psychotherapists, such as clinical psychologists and social workers, were not covered by the study.

Many psychiatrists are solo practitioners who have smaller offices and may have little incentive to hire the extra people needed to deal with insurance companies.

Mental health issues are far from rare. In the United States about one in five adults report having a mental or emotional problem at any given time, and about half will experience some form of psychological disorder during their lifetime.

Yet many people remain untreated. Because of this, there have been calls to increase access to mental health care and to make it easier for people to get treatment.

But people who hope to rely on insurance to pay for mental health treatment may have difficulty seeing a psychiatrist.

Psychiatrists were less likely than any other type of medical specialist to accept private insurance, Medicare and Medicaid, according to data from a national survey of U.S. physicians (NAMCS, 2005-2010). Cardiologists, pediatricians, and general practitioners all were considerably more likely than psychiatrists to accept insurance.

The differences were quite large. Only 55% of psychiatrist accepted private insurance, while 89% of all other doctors did. Medicare was accepted by 55% of psychiatrists and 86% of other specialists and Medicaid was accepted by 43% of psychiatrists and 73% of other doctors.

These disparities widened for private insurance and Medicare (but not for Medicaid) between 2005 and 2010. The likelihood of a psychiatrist accepting insurance has been declining.

Because the survey did not ask doctors why they don't accept insurance, the authors can only suggest possible explanations:

  • Most psychiatrists not working out of hospitals or clinics work in solo practices, and the study found that solo psychiatrists were the least likely to accept insurance. Solo practitioners have smaller offices and may have little incentive to hire the extra people needed to deal with insurance companies.

  • Supply and demand may also play a role. The number of psychiatry graduates has been declining, while the demand to see a psychiatrist has been rising. Psychiatrists may simply be refusing to accept insurance because they can afford to do so.

  • Because psychotherapy sessions are generally longer than the 10-20 minutes many other doctors schedule, psychiatrists see fewer patients in a day and may feel they need to be more selective about who they do see.

Whatever the underlying reasons actually are, the study clearly shows that many psychiatrists are refusing to accept insurance, and this makes them far less accessible to many people who would like treatment.

The study appears in JAMA Psychiatry.