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Study Finds Most Medical Schools Offer Poor Coverage for Mental Health and Substance Abuse Treatment, Imperiling Student and Patient Care
Posted Date: 9/7/2011
New study from Harvard researchers finds nearly 4 of 5 student health insurance plans require co-pays and coinsurance, obstacles to getting needed care, and most impose visit and dollar limits

Cambridge, MA...Most U.S. medical schools offer their students poor health insurance coverage for the treatment of mental health and substance abuse disorders, a practice that imperils the well-being of our nation's future doctors and their patients, a group of Boston-area researchers report in JAMA today.

 In the first study of its kind, the researchers - most of whom are faculty physicians at the Harvard-affiliated Cambridge Health Alliance - found that fewer than 22 percent of the 115 medical schools studied provided their students with complete coverage, without co-pays or coinsurance, for mental health and substance abuse treatment.

 Some student health plans require co-payments of $20-$25 per outpatient visit and up to $500 per inpatient stay. The median coinsurance rate (the percentage of total costs paid by the patient) was 20 percent, meaning that a single course of treatment might cost a medical student thousands of dollars out of pocket.

 "Research shows out-of-pocket costs discourage patients from getting mental health and substance abuse treatment," said Rachel Nardin, MD, assistant professor of neurology at Harvard Medical School, chief of neurology at Cambridge Health Alliance, and lead author of the study. "Everyone, including medical students, deserves full access to all needed care."

 A majority of schools' insurance plans had annual limits on visits and/or total expenditures for mental health and substance abuse treatment. The plans varied considerably in this regard, Nardin said. At least one plan limited annual coverage for outpatient substance abuse care to $800, while another covered the same services up to $200,000 per year.

 "In many cases the maximum dollar benefits can be very low," she said. The number of patient visits allowed by the plans was also quite variable, ranging from eight visits to 150 visits annually.

 Senior author J. Wesley Boyd, MD, PhD, assistant clinical professor of psychiatry at Harvard Medical School and an attending psychiatrist at Cambridge Health Alliance, said: "Medical students experience higher levels of psychological distress than their peers, including depression and suicidality. Such distress correlates with decreases in empathy and altruism among medical students and with increases in medical errors in doctors in training.

 "Given that medical students are often leery about seeking treatment in the first place, requiring students to pay huge co-payments or coinsurance for mental health or substance abuse treatment might foreclose obtaining needed psychiatric care," he said. "This is bad for the students and bad for patients."

 Boyd noted that many ailments persist into later years, so ensuring the ability to receive early treatment is essential.

"US Medical Students' Health Insurance Coverage for Mental Health and Substance Abuse Treatment." Rachel Nardin, MD; Leah Zallman, MD; Cassie Frank, MD, MPH; Benjamin Day, MA; and J. Wesley Boyd, MD, PhD. JAMA, Sept. 7, 2011.

Cambridge Health Alliance is an academic community health system committed to providing high quality care in Cambridge, Somerville and Boston’s metro-north communities. CHA has expertise in primary care, specialty care and mental health/substance use services, as well as caring for diverse and complex populations. It includes three hospital campuses, a network of primary care and specialty practices and the Cambridge Public Health Dept. CHA patients have seamless access to advanced care through the system’s affiliation with Beth Israel Deaconess Medical Center in Boston. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine and Tufts University School of Medicine.