Shirah Vollmer MD

The Musings of Dr. Vollmer

Access To Care

Posted by Dr. Vollmer on April 19, 2016

Kaiser Permanente's lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

Kaiser Agrees to Pay $4 Million Fine Over Mental Health Care


“The clinicians have complained that they weren’t able to offer individual therapy appointments in a timely manner to patients with severe depression, anxiety and other conditions, sometimes leading to wait times of up to four weeks or more between appointments. Others say patients were directed to group therapy, even in cases where the patient wasn’t receptive to group therapy and requested individual care.”


Providing access to mental health care is an essential part of the health care system. Duh. Yet, prior to this lawsuit against Kaiser, patients were told that there is a “mental health department,” but getting appointments at appropriate intervals was simply not happening. Patients were being funneled into groups, which are far cheaper to administer. Now, as I understand it, patients are being funneled towards internet support groups, which is cheaper still. This cost-cutting approach to mental health care ultimately lead  to a major defeat for Kaiser, causing Kaiser and other health care organizations to pour more funds into mental health. Still, the business of health care prevails. Patients are given what makes financial sense for the company, and not what makes sense for that particular individual. Personalized medicine might mean that one’s DNA can be decoded, but it does not mean that the delivery of healthcare is a personal experience. In fact, as technology continues to dominate our lives, healthcare is less and less personal, unless the patient can afford to go outside of the large delivery systems and then they can obtain boutique care. Physicians then become worker bees for a corporation which wants to see a larger bottom line. The focus pivots from the best interests of the patient to the best interests of the company. Sometimes these two goals overlap, but when it comes to mental health care, they are most often in direct contradiction. Listening, the skill I mostly hone, cannot be done if the focus is on limiting resources and lengthening intervals between appointments. Given that my strong feeling is that listening is healing, I wonder how physicians can feel effective when there are overwhelming pressures not to see your patients. I wonder how patients can feel good knowing that their provider has little memory for the previous visit. I am glad Kaiser got sued, but I am sad that they, and all other health care organizations, have created a system which cuts corners until they get caught.

2 Responses to “Access To Care”

  1. Shelly said

    Would this not be true in any HMO? Blue Cross, Blue Shield and any other health care system? I am aware that Kaiser makes patients wait weeks for appointments with psychiatrists, but I was under the impression that Kaiser social workers and other paraprofessionals were easier to get hold of, often calling patients at home to check in with them as needed. While psychiatry is a different world altogether, how many times have you gone to a specialist only to have him/her sit across from you and look blankly at you, not remembering a single thing from your last appointment, and having to read through your history on their computer? My point is that while it is extremely important in mental health that specialists meet often with their patients, psychiatry in HMOs is basically like any other specialty: lost.

    • Yes, indeed. Kaiser is just an example and since they were sued, a glaring one at that. If we see mental suffering as a shout out to developing human caring contact, then this model of care is broken.

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