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Self-pay accounts for nearly 20% of mental health visits by children

June 1, 2024

Nearly one-fifth of visits by children to mental health specialists were paid for by families out of pocket without insurance reimbursement, a recent study showed.

Furthermore, self-pay was more common among families with higher incomes, potentially exacerbating inequities in access, the authors said.

Studies have shown that children in families with lower incomes are less likely to receive mental health care than those with higher incomes. In addition, research has found that psychiatrists are less likely than physicians in other specialties to accept private insurance, and few take Medicaid.

The authors of this study sought to determine how often families self-pay for outpatient mental health care and assess if there are disparities based on income. To do so, they analyzed data from the Medical Expenditure Panel Survey from 2018-2020. They identified mental health visits by children ages 5-17 years to a psychiatrist, psychologist, social worker or mental health counselor/family therapist and determined how many visits were not covered by insurance.

They also looked at the relationship between self-paying and family income.

Among the 9,911 children in the sample, 8% had at least one outpatient mental health specialist visit. Over the two-year period, there were 13,639 total visits.

Seven percent of visits by families with an annual income of less than $28,000 were self-paid, and the median amount this group paid per visit was $95. In comparison, 26% of visits by families who made $110,000 a year or more were self-paid, and the median amount they paid was $120.

Self-pay visits were more common with social workers (24% of visits) and psychologists (23%) compared to psychiatrists (17%) and counselors/family therapists (13%).

The median cost of a self-pay visit for all types of clinicians combined increased from $86 in 2018 to $145 in 2020.

“Our finding that the percentage of visits that were self-paid by families followed a strong income gradient suggests that self-pay mental health care potentially contributes to socioeconomic differences in access to mental health care for children,” the authors concluded.

They also noted that “primary care providers will be key allies in improving equity in child mental health care.”

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