Mon, Dec 31, 2018 - Page 6 News List

Treatments can’t match insurance payments

By Liu Jun-chien 劉潤謙

According to a newspaper report titled “Family feigning illness receives NT$30 million [US$976,149] in decade-long insurance fraud” on Dec. 20, several members of a family allegedly faked symptoms of mental illness such as depression to mislead doctors, who repeatedly hospitalized them. The family members are being investigated for allegedly defrauding insurers after receiving hospital treatment.

The reports raise the question: Is it really is so easy to fake mental illness? Are psychiatrists easily fooled and are treatments ineffective?

First, why mental illness? The main reason is that it differs from regular diseases, because there are no objective data. For example, high blood pressure, blood sugar levels and infections can be objectively measured and the results cannot be fabricated. Emotional symptoms are different, because depression is a subjective feeling that cannot be quantified. During training, doctors are not taught to expect patients to lie and so they mostly believe them.

Second, while most people who are diagnosed with depression or anxiety do have mental issues, they often exaggerate the symptoms, for example through self-harm. In a way, they do have an unhealthy mental state, and need therapy and assistance.

There are indeed such diagnoses in clinical psychiatry, called malingering and factitious disorder. The difference is that the former is intentional, while the latter is not.

For example, a person with a monthly income of NT$20,000 to NT$30,000 might be in dire economic straits and highly indebted, leading to depression and hospitalization. They realize that insurance payments will increase their income to between NT$100,000 and NT$150,000. After being discharged, they return to being overworked and are under even greater economic pressure.

Exiting the healthcare system leads to even more depression, and they might injure themselves to re-enter it. How should such a situation be treated from a clinical perspective?

Some insurance companies and agents sell large insurance policies primarily to improve their results. However, while they benefit from the high insurance fees, they want psychiatrists to cure their clients, which helps the insurance company save money on payments.

Instead of controlling the problem at the front end, they are asking doctors to solve it for them. This is quite a favor to ask.

Providing treatment to people with depression or anxiety is a psychiatrist’s expertise and most patients’ mental conditions can be greatly improved after receiving proper treatment.

As for people who are unwilling to recover due to insurance payouts, a cure is not readily available.

Insurance is a matter of risk management and it should be tailored to individual needs. If insurance companies do not have appropriate risk management policies and sell large insurance policies to boost profits, then the problem of people receiving insurance payments that exceed their income cannot be treated by doctors.

After all, when competing with huge insurance payouts, even the best medicine or therapy might have limited effect.

Liu Jun-chien is a psychiatrist at the Tainan branch of Kaohsiung Veterans General Hospital.

Translated by Eddy Chang

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