The impact of third-party payment cutbacks on the private practice of psychiatry: three surveys

Recent cutbacks in private insurance benefits and publicly funded health programs are threatening the access of Americans, particularly the poor and the disabled, to private psychiatric care. The authors present the findings of three surveys that assessed the impact of threatened or actual cuts in third-party payments on the treatment provided by private practitioners. One survey indicated that, contrary to popular opinion, more than half of the psychiatrists in Northern California see severely disturbed Medicaid patients and that they provide outpatient psychiatric services to them for less cost than would public clinics. Two surveys conducted in the Washington, D.C., area indicated that both patients and psychiatrists have suffered from insurance cutbacks, with fewer patients being able to afford intensive private treatment and psychiatrists using reduced fees and less optimal treatment modalities. The fiscal and ethical dilemma posed by the cutbacks and further research needs are also explored.