The investigation, led by Simon Haeder and Wendy Xu of Ohio State’s College of Public Health and published in JAMA Health Forum, employed a secret-shopper methodology that has become a gold standard for testing whether healthcare access claims survive real-world contact. The research team placed 5,822 calls to mental health providers listed in commercial insurance networks in Delaware, Montana, New Jersey, Rhode Island and Virginia. Callers presented scenarios involving common concerns such as anxiety and grief, then documented whether they could actually reach a human being and, ultimately, book an appointment with an in-network clinician.

The headline numbers are stark. A successful call, defined simply as one in which a live person answered the phone, resulted in an appointment with the listed provider only 24 percent of the time. When callers expressed willingness to see any clinician in the practice rather than the specific one listed, the success rate rose only modestly, to 31 percent. In other words, roughly seven in ten attempts to use an insurance directory for mental health care ended without an appointment, even after the caller had already demonstrated persistence by getting someone on the line.

Compounding the problem, the researchers could not analyze more than six in ten of all calls because those attempts never reached a person at all. Automated phone systems and answering machines absorbed the majority of contact attempts, a barrier that is particularly punishing for people already hesitant to seek mental health treatment. Among the 2,252 calls that could be fully analyzed, 56 percent revealed inaccurate information in the provider directory, meaning the listed phone numbers, locations or practice affiliations did not match reality. Another 22 percent of calls failed to produce an appointment because of capacity constraints, most commonly providers who were not accepting new patients at all.

Even when callers managed to navigate the obstacles and reach a practice with room in its schedule, time itself became a barrier. The average wait for care was 20.5 days, with appointments for psychiatry taking longer to secure than appointments for psychology. For someone in acute distress, a three-week delay can mean the difference between a manageable episode and a crisis, and the researchers noted that such waits compound the difficulty of an already daunting decision to seek help.

Haeder attributed the directory failures to the churn of clinical practice colliding with static databases. Providers move, change phone numbers, leave practices or otherwise become unavailable, but those changes are not always reflected in insurance directories. The study also describes a phenomenon the researchers call ghost providers or ghost networks: clinicians who appear to exist on paper because insurers list them as part of a contracted group, even when those individual clinicians are not actually available to patients. The listings inflate the apparent size of a network while doing nothing to expand real access, creating what the authors characterize as networks that exist in documentation but not in practice.

Xu, a professor of health services management and policy, framed the findings as evidence of a broader disconnect at the heart of American healthcare: the gap between having insurance and being able to use it. Inaccurate provider directories, she argued, are not merely an administrative inconvenience. They can create substantial barriers to care, leaving people effectively underinsured despite carrying coverage. The finding is especially worrisome in the mental health context, where the act of seeking help can already be difficult for someone experiencing anxiety, grief or another concern, and where encountering answering machines, unavailable providers and in-network psychologists who have moved to another state can extinguish a person’s motivation to keep trying.

The researchers emphasized that directory inaccuracy is a longstanding, systemic problem across medical specialties, not a quirk of mental health networks, and that its roots lie in several structural challenges. Regulation and enforcement are inconsistent from state to state and across plan types, and insurers face incentives to present large provider lists to regulators, employers and consumers, since a longer list suggests stronger access regardless of whether the listed clinicians are reachable. There is little penalty for listings that turn out to be wrong, and verifying thousands of individual entries is costly, so the burden of accuracy falls on no one in particular while the consequences fall on patients.

Potential remedies, according to the study team, include rethinking how directory data is created and maintained. Haeder proposed a centralized provider directory that clinicians themselves maintain and that insurers can access, rather than every insurer separately trying to keep its own database current. Such a system would shift the responsibility for accuracy to the people who know their own availability best and would eliminate the duplicated, divergent records that currently populate insurance networks. The researchers also suggested that stronger verification requirements and more consistent enforcement of existing network-adequacy rules could pressure insurers to prune ghost listings and confirm that the clinicians they advertise are genuinely accepting patients.

The study, which included contributions from Ohio State doctoral student Yuqin Lou and Benjamin Miller of Stanford University, received funding from Inseparable, a national mental health advocacy organization. Its publication in JAMA Health Forum, under the title Mental Health Ghost Networks in Commercial Insurance Plans, adds rigorous secret-shopper evidence to a growing body of documentation showing that provider directories across American healthcare often fail the patients who depend on them. For the millions of insured Americans who assume that a long list of in-network therapists means help is a phone call away, the message of the research is sobering: the card in the wallet guarantees coverage, but the directory that is supposed to translate coverage into care frequently does not, and the people most in need of appointments are the least equipped to fight through the answering machines, ghost listings and weeks-long waits that stand in their way.

Subject of Research: Having insurance doesn’t mean you can get a mental health appointment

Article Title: Having insurance doesn’t mean you can get a mental health appointment

Article References: Having insurance doesn’t mean you can get a mental health appointment. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: mental health, health insurance, provider directories, healthcare access, JAMA Health Forum, Ohio State University, ghost networks, Having, insurance, doesn, mean, mental

Patient navigators are trained guides who help patients access care and resources while working alongside the clinical team. In the trial, conducted at Prentice Women’s Hospital in Chicago between 2020 and 2024, 405 pregnant individuals were enrolled near the end of their pregnancies and supported throughout the first year after delivery. The navigators, all of whom spoke both English and Spanish, created individualized postpartum care plans with their patients and shared those plans with the medical team. They scheduled and attended appointments, coordinated social needs such as transportation and childcare, communicated with doctors and nurses, and helped patients make sense of complex medical information. Crucially, they also worked to build what researchers call self-efficacy skills, improving health literacy so that patients could eventually manage their own care independently.

The results were striking across nearly every measure the researchers tracked. Compared with patients who received usual postpartum care, those paired with a navigator were far more likely to attend their postpartum visits—96 percent versus 80 percent. They were more likely to be counseled about all needed postpartum topics, at 65 percent versus 51 percent, and more likely to receive screening and care for postpartum depression during the critical months often described as the fourth trimester, at 86 percent versus 72 percent. The differences persisted well past the immediate postpartum period: at one year after giving birth, 57 percent of navigated patients had attended a primary care visit compared with just 30 percent of those without a navigator.

Preventive health testing told a similar story. Navigated patients were substantially more likely to receive blood pressure checks, at 85 percent versus 62 percent, along with lipid panels at 28 percent versus 13 percent and glucose testing at 31 percent versus 16 percent. They were also more likely to be using their desired family planning method, such as birth control, at one year postpartum—65 percent versus 43 percent—a measure that matters both for individual health and for helping patients space out future pregnancies safely. Taken together, the numbers suggest that navigation does not merely nudge patients toward a single appointment but reshapes their entire trajectory of engagement with the healthcare system.

The stakes of this engagement are considerable. Previous research has shown that pregnancy complications such as gestational diabetes and preeclampsia can have lasting effects on long-term health, particularly cardiovascular and metabolic health, which makes the transition from obstetric care back to primary care a pivotal moment. Even patients with entirely healthy pregnancies can face serious postpartum challenges, including postpartum depression, unfulfilled social needs such as lack of partner support or housing instability, and safety risks like domestic violence. Any of these can make it extraordinarily difficult for a new mother to prioritize her own health. Corresponding author Dr. Lynn Yee, chief of maternal-fetal medicine in the department of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, explained the underlying problem: pregnancy and the postpartum period are complex, and people often deprioritize themselves, particularly when they lack support or face complex social needs. Combined with a fragmented healthcare system, she noted, many people simply do not receive the care they need.

Yee described the resulting situation as a perfect storm of suboptimal women’s health during a key postpartum period—the very time when many women drop out of care altogether. If that gap can be addressed early and patients’ engagement with healthcare can be sustained, she argued, the payoff extends across the long run, improving health and well-being for years. The implications ripple outward as well. As Yee observed, cumulatively failing to engage in health-promotion behaviors during the postpartum period has reverberating implications for the entire family unit, since a mother’s health underpins the wellbeing of her infant and household.

The trial also documented benefits flowing in the other direction, toward clinicians. The medical care teams at Prentice Women’s Hospital came to appreciate the navigators’ assistance in concrete ways. Navigators would alert a doctor when a patient could not attend an appointment and reschedule it, for example, or complete administrative tasks that would otherwise consume clinical staff time, thereby freeing up the care team. They also made sure patients followed through on post-appointment tasks, such as completing a glucose tolerance test or attending a subsequent visit. Joseph Feinglass, research professor of general internal medicine at Feinberg and a co-author of the study, said one of the goals of navigators was not just to help patients but to help clinicians too, and that doctors were happy at how much more efficient and engaged their patients became.

Firsthand accounts from the navigators themselves illustrate how the model works in practice. Viridiana Carmona-Barrera, who worked in hospital, insurance, and women’s health settings before joining the study, described one pregnant patient with chronic health conditions who was at risk of missing a critical appointment because of transportation and childcare challenges. When other outreach efforts fell short, Carmona-Barrera coordinated both transportation and childcare so the patient could attend. She said she likes being someone who can help make these processes easier, noting that as committed as healthcare organizations are to supporting patients, navigating the system can still be challenging—a candid acknowledgment that even well-resourced institutions leave gaps that individual patients cannot always close alone.

Perhaps the most distinctive feature of the Northwestern program is its explicitly temporary ambition. Rather than creating permanent dependence on a support service, the authors designed navigation to build patients’ independence and comfort with engaging the healthcare system, so that they would not need a navigator in the future and would continue seeking primary care on their own. Yee put it memorably: the navigators’ goal was to put themselves out of business, to reach the end of the year and be able to tell a patient that she no longer needed them. That, she said, is success for a navigation program. This self-sufficiency framing distinguishes the intervention from models that simply add services, positioning navigation as a bridge rather than a crutch.

The broader significance of the trial lies in what it could mean for policy and practice. In cancer care, patient navigation has moved from a promising idea to an institutionalized component of treatment, supported by Medicaid funding and embedded in oncology programs nationwide. Maternal health, by contrast, has seen little of this investment despite persistent disparities in postpartum outcomes, particularly among low-income populations who face barriers such as inadequate health literacy, unreliable transportation, limited access to childcare, and insecure housing—any of which, the researchers note, can be the tipping point between a new mother accessing needed care or going without it. By demonstrating measurable improvements in postpartum visit attendance, depression screening, preventive testing, and long-term primary care engagement, the Northwestern findings lay the groundwork for future research and for potential funding mechanisms that could bring patient navigation to postpartum care at scale. The study, titled A randomized trial of patient navigation to improve postpartum health care, offers what its authors describe as an outline of what ideal postpartum care in the United States should look like—and a practical, testable path toward achieving it.

Subject of Research: Patient navigation to improve postpartum healthcare engagement among low-income mothers

Article Title: Moms of infants overcome barriers to postpartum care with help from patient navigators

Article References: Moms of infants overcome barriers to postpartum care with help from patient navigators. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: patient navigation, postpartum care, maternal health, randomized trial, Northwestern University, JAMA Health Forum, primary care transition, postpartum depression, health literacy, low-income mothers, fourth trimester, preventive care

The study’s central conclusion is stark: many hospitals that still maintained obstetric services as of 2023 may be at high risk of losing them in the near future. That projection matters because obstetric care is not a discretionary service. When a hospital stops delivering babies, pregnant patients must travel farther for prenatal visits, labor and delivery, and emergency obstetric interventions, and the consequences of delayed care can be severe. Researchers have long documented that rural communities experience the sharpest effects, with longer travel distances linked to worse outcomes for both mothers and infants. But the new analysis makes clear that urban hospitals are not immune, and that the forces eroding obstetric access operate differently in different settings.

Birth volume emerged as one of the most consequential predictors of obstetric loss. Hospitals that deliver relatively few babies each year face a structural dilemma: maintaining a round-the-clock obstetric team, including physicians, nurses, anesthesiology coverage and surgical capacity for cesarean sections, is expensive regardless of how many patients walk through the door. When deliveries are infrequent, the fixed costs of staffing a labor and delivery unit are spread across fewer cases, driving up the per-birth cost and making the service difficult to sustain. Low-volume units also raise clinical concerns, because clinicians who rarely manage obstetric emergencies may have fewer opportunities to maintain the skills and team coordination that safe childbirth care demands. The study’s finding that lower volume was associated with subsequent obstetric loss fits this economic and clinical logic, and it suggests a self-reinforcing cycle in which declining births push hospitals toward closure, which in turn pushes patients to travel elsewhere, further reducing local volume.

Financial performance was a second major thread in the analysis. Hospitals whose obstetric services were unprofitable were more likely to lose them, a result that underscores the uncomfortable reality that childbirth care often operates on thin or negative margins. Obstetric units generate costs that are not always matched by reimbursement, particularly for facilities serving large shares of patients covered by Medicaid, which typically pays less than private insurance. Payers and administrators frequently describe obstetric care as a loss leader, a service a hospital absorbs because it draws patients and families into its system, or because community need demands it. When overall hospital finances deteriorate, or when ownership priorities shift toward profitability, obstetric services become vulnerable. The finding that unprofitability predicted obstetric loss provides quantitative support for what hospital administrators have long said anecdotally: money, or the lack of it, sits at the heart of many closure decisions.

Geography played a subtler but equally important role. Hospitals located near another hospital offering obstetric care were more likely to lose their own obstetric services. This proximity effect can be read in two ways. From a system-planning perspective, a nearby alternative may make closure seem tolerable, because patients have somewhere else to go, and administrators or health systems may consolidate services to concentrate volume and expertise at one site. From a patient’s perspective, however, even a seemingly short distance can become a meaningful barrier, particularly for people without reliable transportation, for those who go into labor unexpectedly, or for those in areas where weather, road conditions or traffic can turn a short drive into a long one. The study’s attention to proximity highlights that closure decisions are shaped not only by what happens inside a hospital but by the competitive and geographic landscape surrounding it.

Ownership status also mattered. For-profit hospitals were more likely to experience obstetric loss than their not-for-profit counterparts. This association is consistent with a broader body of health services research showing that for-profit facilities face stronger pressure to eliminate services that do not generate returns for shareholders or owners. Childbirth care, with its unpredictable timing, high staffing requirements and frequent reliance on public insurance, fits poorly with that pressure. The finding does not mean that every for-profit hospital will abandon obstetrics, but it flags ownership as a structural risk factor that policymakers and regulators can observe in advance, potentially allowing earlier intervention in communities where access is threatened.

One of the study’s most valuable contributions is its recognition that obstetric loss is not a single phenomenon. The researchers distinguished between hospitals that closed their obstetric units while remaining open for other services and hospitals that shut down entirely, and they found that the importance of specific risk factors varied by type of loss. A hospital that closes its obstetric unit but continues operating is making a service-line decision, often driven by the economics of the obstetric service itself. A hospital that closes entirely removes all inpatient care from a community, and obstetric services disappear as part of a broader collapse. The predictors of these two outcomes are not identical, and treating them as interchangeable risks obscuring the different policy responses each requires. Similarly, the analysis found that risk factors operated differently in rural and urban hospitals, reinforcing that a one-size-fits-all approach to sustaining obstetric care is unlikely to succeed.

The rural-urban distinction deserves particular emphasis. Rural hospitals have faced a well-documented wave of closures and service reductions, driven by low patient volumes, chronic financial strain, workforce shortages and payer mix. In rural areas, the loss of obstetric care often means that the nearest delivery hospital is dozens of miles away, and some counties are left with no local obstetric services at all. Urban hospitals, by contrast, may close obstetric units in the context of dense hospital markets, where consolidation and competition shape service lines, and where patients can usually reach alternative facilities more easily. Yet even in urban settings, closure can concentrate burdens on specific neighborhoods, often those with higher poverty rates and historically limited access to care. By analyzing rural and urban hospitals separately, the study provides a more granular map of vulnerability than earlier work that lumped all closures together.

The policy implications of the findings are significant. If lower birth volume, unprofitability, proximity to alternatives and for-profit status reliably signal elevated risk, then regulators, state health departments and health systems can use these characteristics to identify hospitals that may be approaching an obstetric closure decision, potentially before it happens. Early identification opens the door to interventions ranging from payment reforms that better compensate low-volume obstetric care, to regionalization strategies that pair smaller units with larger referral centers, to workforce programs that ease staffing burdens. The study also suggests that closure decisions should not be evaluated solely on hospital-level finances, since the community consequences of losing childbirth services, including longer travel times and potentially worse maternal and neonatal outcomes, extend well beyond the balance sheet of the facility making the decision.

For the many hospitals that still deliver babies, the study’s warning about future risk lands at a moment when maternal health outcomes in the United States remain a source of national concern and when access to timely obstetric care is increasingly recognized as a determinant of those outcomes. The research by Interrante and colleagues does not predict which specific hospitals will close their doors or their delivery units, but it identifies the characteristics that place facilities on a higher-risk path and shows how those characteristics differ across settings and types of loss. As health systems, insurers and policymakers weigh how to preserve childbirth access in vulnerable communities, the study offers a data-driven starting point: pay attention to volume, margins, geography and ownership, because those are the factors most closely tied to whether a community’s next baby is born nearby or hours away.

Subject of Research: Risk factors associated with the loss of hospital-based obstetric care in rural and urban U.S. hospitals

Article Title: Risk factors for loss of hospital-based obstetric care in rural and urban hospitals

Article References: Risk factors for loss of hospital-based obstetric care in rural and urban hospitals. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: obstetric care, hospital closures, rural health, birth volume, hospital finances, for-profit hospitals, maternal health, health policy, JAMA Health Forum, healthcare access, rural hospitals, urban hospitals