Access and cost barriers to mental health care, by insurance status, 1999-2010

Health Aff (Millwood). 2013 Oct;32(10):1723-30. doi: 10.1377/hlthaff.2013.0133.


The cost of mental health services has always been a great barrier to accessing care for people with mental health problems. This article documents changes in insurance coverage and cost for mental health services for people with public insurance, private insurance, and no coverage. In 2009-10 people with mental health problems were more likely to have public insurance and less likely to have private insurance than in 1999-2000. Although access to specialty care remained relatively stable for people with mental illnesses, cost barriers to care increased among the uninsured and the privately insured who had serious mental illnesses. The rise in cost barriers among those with private insurance suggests that the current financing of care in the private insurance market is insufficient to alleviate cost burdens and has implications for reforms under the Affordable Care Act. People with mental health problems who are newly eligible to purchase private insurance under the act might still encounter high cost barriers to accessing care.

Keywords: Health Reform; Insurance Coverage/Insurance; Mental Health/Substance Abuse.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Health Policy
  • Health Services Accessibility / economics*
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health*
  • Mental Health Services / economics*
  • Middle Aged
  • Patient Protection and Affordable Care Act
  • Private Sector
  • Public Sector
  • Qualitative Research
  • Young Adult