American psychiatrists reject insurance, Japanese reject spending time

A newly study clarified that psychiatrists tended not to accept health insurance, compared to other specialist doctors. This result was introduced by major media, to cause broad arguments.

JAMA Psychiatry: Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care

The New York Times: Fewer Psychiatrists Seen Taking Health Insurance

JAMA Psychiatry, Archives of General Psychiatry in the past, is one of the most authorized journal in the region of psychiatry. I read this article in the other day to confirm that there are no errors in this survey. The conclusion is that the rate of accepting health insurance in psychiatry is lower than in other medical area, in addition, is decreasing in recent years.

If a doctor does not take health insurance, the patients should pay much more money to be given treatment. So, some people will criticize the attitude of psychiatrist as greed. However, there are some complicated problem behind the fact.

Psychiatric News Alert: The Truth About Psychiatry and Health Care Insurance

First, the number of psychiatrists does not match the need for psychiatric service in the US, according the article. Shortage of supply leads the increase of price in a free economy.

Second, the rate of reimbursement seems to be low in psychiatric care. It may discourage psychiatrist accepting insurance. I guess that the backbone of this matter is the difficulty of ensuring the quantitative effect of psychiatric treatment.

Third, the fee for psychiatric care per working time is set relatively lower than physical treatment. Psychiatrists cannot earn as the same amount of money as other specialist physicians on the rule of insurance. This situation is the same also in Japan. Japanese psychiatrists have to deal with lots of patients, e.g. 40 in a day, regularly to maintain his outpatient office.

The difference between the US and Japan is that Japanese psychiatrists always adhere to health insurance. In Japan, national health insurance is extremely infiltrated to the society. Only a few doctors take no insurance, regardless of their specialties. On the other hand, there are several outpatient offices in which some psychotherapists offer psychotherapy not accepting health insurance. They spend adequate time for each patient. Otherwise, psychiatrists have a conversation with the patients for only a few minutes per visit in usual. The quality of these counselling offices is various. Thus, patients in Japan pay extra money to buy the time to talk, not for care itself. Restructure of health insurance followed by quality control is required in Japan.