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Elusive mental health care, do-it-yourself abortion, and questions on cancer screening

June 2, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Features:

Access to mental health care remains elusive for many Americans, despite passage of the Mental Health Parity and Addiction Equity Act of 2008 and the ACA in 2010. Cash is often paid for mental health services and often precludes the poor from receiving needed care. KQED this week features the frustrations of Stanford psychiatry professor Keith Humphreys, PhD,  who complains that many of his trainees, instead of taking care of the seriously mentally ill, prefer opening lucrative private practices where they charge up to $400 an hour to take care of the so-called “worried well.” These [patients] are individuals, he says, who do not necessarily have mental health problems, but are mainly interested in self-exploration. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.” In fact, finding mental health care providers for most patients, even for those who have insurance, can be challenging, given copays and other care limitations that insurers have put in place to restrict coverage. Consider Natalie Dunnege, a single mom seeking therapy, featured in a subsequent KQED segment. She learned her copay for a mental health visit would be $75, more than she could pay. But that was only one barrier to care. KQED staff called 100 psychologists listed in Dunnege’s health plan directory to find out about access. Twenty two of them never called back; two had wrong numbers; 48 said they weren’t taking insurance or new patients; and only eight had appointments available after regular work hours.

In Reuters this week, we learn about a shocking practice in Texas that so far has affected more than 100,000 women—do-it-yourself abortions. Laws restricting abortion since 2013, such as requiring clinics to meet the rigors of hospital standards, forced many clinics in the state to close and left women, especially poor women, without care. In Texas there are now only 20 clinics for the 5.4 million women of reproductive age, leaving many women to drive hours to reach the nearest one. In addition, many women who can reach a clinic, might not be able to afford the cost of an abortion. Unable to afford an abortion, Susanna, a 23-year-old whose plight is featured in the article, drove to a pharmacy in Mexico to purchase over-the-counter misoprostol, an abortifacient that cost her $19. Instructions for its use are readily available on various websites, including the World Health Organization’s. The drug is known to induce abortions with heavy bleeding and contractions, and for Susanna, that process, which she describes as “almost primal,” lasted 12 hours. Jill Adams, executive director of the Center on Reproductive Rights and Justice at the University California, Berkeley Law School predicts that “this is a trend we only anticipate growing in light of many factors, including this spate of state-level provisions on access that are resulting in clinic closures.” Adds Susanna, “They’re trying to make us jump through all these hoops. It’s like a war on the poor people.”

In an essay for the American Enterprise Institute, Joel Zinberg, MD, JD, a visiting scholar, questions routine screening for cancer, given its questionable effectiveness and high cost. He writes “Healthy patients are often pressured to undergo screening and are rarely provided with the knowledge needed to make an informed decision.” Even cervical cancer screening, which is widely seen as being effective in reducing deaths, comes in for Zinberg’s scrutiny. He notes that annual screening costs are $8 billion for breast cancer, $6 billion for cervical and $3 billion for prostate cancer, and then there are costs for treatments. The reasons for promoting screening, he writes, “are more political than scientific. Patient-advocacy groups attract donations, gain prestige and accumulate power by pushing screening for particular diseases. Physician-specialty groups promote screening in their areas of expertise. Most important, politicians of both parties garner support by funding screening programs for important constituent groups…Many screening programs mislead the public, waste scarce medical resource, and harm the people they are supposed to help.”

Headlines:

Overuse

Social determinants

End-of-life care

Safety

Access

Nursing

Guns

Global

Cost of care

Pharma

Evidence

Confidentiality

Patient communication

 Homelessness

 

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