To the Editor: While I found the article by McConnell et al. (1) in the January issue to be of great interest, I believe there may be other factors contributing to cost control in Oregon than those addressed by the authors. It is my impression, albeit without specific evidence, that insurance reimbursement rates in Oregon are lower than those in many other states, and I am definitely aware that insurance companies have been lowering such rates in recent years. Related to this, we are seeing a declining number of psychiatrists in Oregon as retirement attrition continues, with fewer new psychiatrists starting practices. In addition, insurance companies have highly restrictive panels that make it difficult to find nurse practitioners, social workers, and psychologists.

As a result, we are seeing more colleagues who have 3-month or longer waiting lists or who are closing practices to new patients. I believe that lack of supply is helping to keep costs down, but there has been a significant impact on the availability and quality of care.