Digital Therapy for Mental Health in the United States: The Inherent Paradox of Accessibility and Scale

Although the field of mental health has long been one of the hottest online medical fields, the catalyst for the development of this market comes from the epidemic
.

The US mental health market is huge.
Almost one-fifth of Americans have sought psychiatric treatment, but due to a shortage of supplies, only 20% of them received treatment in the end
.

According to the "American Mental Health Market Report" released by market information company OPEN MINDS in 2019, the size of the American mental health market is USD 225.

However, despite the seemingly huge demand, the development of the medical service market for mental health is weak.
This is due to three reasons: low payment prices, insufficient supply of physicians, and poor accessibility caused by the first two
.

First of all, the income of psychiatrists is the bottom five of all specialists in the United States.
This is mainly because the US medical insurance and commercial insurance pay less for psychiatrists than other specialties
.

Commercial insurance pays a price range of US$65-250, while Medicare’s price for a 45-minute conversation treatment is US$86 and Medicaid is US$83.

According to a survey released by JAMA Psychiatry in 2014, only 55% of psychiatrists receive commercial insurance, while the average acceptance rate for other specialties is 89%
.

Similarly, only 55% and 43% of psychiatrists receive Medicare and Medicaid, respectively, while the average acceptance of other specialties is 86% and 73%

Secondly, due to the low price paid, the number of graduated psychiatrists has slowed down.
Between 2001 and 2010, the number of psychiatrists only increased by 6%, while other specialties increased by 20%
.

According to a survey of doctors' salaries by medical hunter Merritt Hawkins in 2019, the average annual income of psychiatrists is only $273,000, which is slightly higher than the average starting salary of family doctors, but only 50% of the income of orthopedic doctors is less than that

Finally, due to low insurance coverage and limited supply, the accessibility of the American mental health market is facing greater challenges
.

The challenge of the accessibility of spiritual services does not only come from the lack of supply in rural areas, but more importantly, doctors do not accept insurance payments.

Therefore, there is a certain self-financed user base in the mental health market, which will help digital medical startups to develop seed users from the early stage.
However, if they want to achieve large-scale development, they still need to rely on the payment of enterprises and insurance companies, and the price is still the main competition.
Advantage
.

However, as the epidemic has restricted offline medical services, mental health services that are most easily converted to online have experienced explosive growth, and mental health accounts for 50% of the number of online consultations
.

Due to the surge in psychological problems caused by the epidemic, companies are also willing to pay for their employees' mental health in order to ensure production efficiency

However, the shortage of psychiatrists has not been resolved due to onlineization, and the quality of many online services cannot be guaranteed
.

Some media reports that companies like Talkspace still have discontinuous service quality or poor service accessibility.

Of course, digital therapies in the form of prescriptions rely more on algorithms and software to intervene, which will reduce dependence on doctors and help reduce labor constraints.
This is also the reason why companies like Pear Therapeutics have gained market attention
.

However, digital therapy developed in the form of prescriptions has gone from one extreme to the other

Furthermore, although prescription digital therapies are less dependent on manpower, their access has not changed.
It also requires doctors to write prescriptions and keep track of patients to ensure effectiveness
.
However, the price of digital therapy is not high (ranging from US$100-500 per month), and the cost of services that can be allocated to doctors is also very limited, and it will take up the doctor’s time and have joint responsibility for the doctor, and the doctor’s willingness to write a prescription Is not high
.
In prescription digital therapy, only one app can be used for one symptom.
Mental health needs often have multiple symptoms at the same time, and mental health is mainly talk therapy (Talkspace changed it to written communication to reduce costs.
), relying solely on software intervention is difficult to achieve real results
.

Therefore, restricted by its own development model, it is difficult for prescription digital therapies to unify the interests of doctors, patients, and payers, and cannot be scaled up
.
The prescription-free digital therapy guarantees the clear benefits of payers, doctors, and patients, thus achieving rapid growth.
However, the shortage of psychiatrists will restrict the development of mental digital therapy in the long term
.