Behavioral health care is considered the country’s most costly health condition, at an estimated annual expenditure of $201 billion. Despite the significant expense associated with behavioral health care, unmet need remains high. Behavioral health provider shortages and associated maldistribution of practitioners across the country may contribute to suboptimal behavioral healthcare availability, with an estimated 59.8% of the 5,035 mental health provider shortage areas in the U.S. located in rural and partially rural areas.
This study examines the relationship between reimbursement and provider shortages within the behavioral health workforce. We hypothesize that variation in reimbursement across the country contributes to disparities in the geographic distribution of behavioral health providers, and that these providers are responsive to variation in reimbursement through their practice location. This population is anticipated to be particularly vulnerable to geographic disparities in pay owing to consistently lower reimbursement rates than their non-behavioral health peers. Although federal and state policies, namely parity laws, intend to address inequitable design of reimbursement rates between behavioral health and non-behavioral health providers, disparities remain in payment. We hypothesize that reimbursement within a geographic area will be positively correlated with number of behavioral health providers in this region using a case study of licensed psychologists in metropolitan areas.


A case study of clinical, counseling, and school psychologists in 230 metropolitan areas were analyzed to examine the relationship between reimbursement and behavioral health provider geographic distribution. Across all metropolitan areas, less than 1% of the total non-civilian institutionalized population were psychologist and the average wage was $33.69 per hour. This study found a positive correlation between hourly median wage and percentage of residents who identified as a psychologist. This relationship holds true when controlling for racial distribution, employment, veteran status, household income, education, and disability.


Behavioral Health Provider Geographic Distribution and Reimbursement Inequities

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