How does clients' method of payment influence psychologists' diagnostic decisions?
To what extent does payment method (managed care vs. out of pocket) influence the likelihood that an independent practitioner will assign a Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnosis to a client? When a practitioner does diagnose, how does payment method influence the specific choice of a diagnostic category? Independent practitioners responded to a vignette describing a fictitious client with symptoms of depression or anxiety. In half of the vignettes, the fictitious client intended to pay via managed care; in the other half, the fictitious client intended to pay out of pocket. Payment method had a very significant impact on diagnosis such that relative to out-of-pocket clients, managed care clients were much more likely to receive diagnoses and more likely to receive adjustment disorder diagnoses in particular. We discuss implications involving informed consent and other ethical issues.
Kielbasa
Amy M
AM
Department of Psychology, Southern Illinois University, Campus Box 1121, Edwardsville, IL 62026, USA. apomera@siue.edu
Pomerantz
Andrew M
AM
Krohn
Emily J
EJ
Sullivan
Bryce F
BF
D001007:Anxiety / Q000175:diagnosis; D003625:Data Collection; D003657:Decision Making; D003866:Depressive Disorder / Q000175:diagnosis; D006801:Humans; D007258:Informed Consent; D008329:Managed Care Programs; D001523:Mental Disorders / Q000175:diagnosis*; D008605:Mental Health Services / Q000191:economics; D011584:Psychology; D011613:Psychotherapy; D012051:Reimbursement Mechanisms