Impact of Behavioral Health Problems on Access to Care and Health Services Utilization‪.‬

Introduction Access to health care services has become a key performance benchmark in most health care systems. This is especially important in the current era of capped budgets and reductions in Medicare and Medicaid reimbursement. In many large metropolitan areas, the safety net is in peril as downsizing has become necessary [Zuckerman, et al., 2001]. Some areas of the country have no public hospital to serve as this safety net. Thus, community hospitals have had to absorb the additional workload [Health System Change, 1998-99]. In such areas, Medicaid patients report difficulty obtaining appointments with private pediatricians and primary care providers. According to data from the National Comorbidity Survey, for those respondents with three or more lifetime psychiatric disorders, only 60 percent ever receive any care for those illnesses, only one-third receive care for a current episode, and only one-fifth receive any specialty mental health care for the current episode [Kessler, et al., 1994]. Thus, it appears that access to care for behavioral health problems is a particularly problematic area in the current health care system. The Community Tracking Study, which tracks changes in the U.S. health system in 60 sites representative of the nation, reported that 16 percent of patients in metropolitan areas believed that their doctor might not refer them to a specialist when needed. Twenty-five percent of physicians stated that it was not always possible to provide high-quality care to all of their patients. Of the primary care physicians: 20 percent reported difficulty in obtaining referrals to high-quality specialists for their patients, though medically necessary [Health System Change, 1998-99].