Put six clinic attributes on a card and ask people to circle two. That is roughly what we did with 443 adults across the Midwest, and the pattern they produced is a useful map for anyone who sends patients to depression care.

The question was simple: when choosing a provider for one of the newer depression treatments, esketamine or ketamine, which two things matter most? The options were insurance coverage, closeness to home, fast results, FDA approval, privacy, and specialization in veterans and first responders. Below they are compared side by side.

These are top-line results from the whole sample, drawn from the final validated responses.

The ranking at a glance

Takes my insurance: chosen by 85 percent
Near where I live: 43 percent
Carries FDA approval: 27 percent
Quick results: 24 percent
Privacy and discretion: 11 percent
A clinic geared to veterans and first responders: 10 percent

Since everyone picked two, the column adds up to about 200. The useful reading is relative. Coverage outpolled the next attribute by roughly two to one, and the bottom two together drew fewer mentions than proximity alone.

Coverage versus everything else

This is not a close contest. More than four in five people made insurance one of their two picks. No other attribute reached half.

For a referrer, the implication is that coverage works like a gate, not a preference. A patient does not trade it off against a shorter drive or a better waiting room. If the clinic is out of network, many will not call at all. Another question in the survey supports this: for 65 percent, coverage was deciding or big when it came to trying the treatment at all.

What it means in practice: before any other comparison, sort your referral options by which plans they accept. Patients who ask what they might owe can start with this plain summary of treatment costs and coverage. Your patients' plans are more varied than you might assume. In our sample, commercial plans (39 percent) ran nearly even with Medicaid (37 percent), and Medicare reached 23 percent.

Close to home versus fast results

Here the comparison gets interesting. Proximity outpolled speed by a wide margin, 43 percent to 24 percent. Patients seem to value a treatment they can actually attend over one that might work faster somewhere else.

That preference fits the shape of esketamine care. The approved nasal spray is administered at certified sites, where staff observe each patient for a while after the dose, and patients need someone else to drive them home. Early on, visits are frequent. For many people, a clinic twenty minutes away is simply more realistic than one an hour out, whatever its reputation for speed.

There is also a caution on the speed side. Patients who rank fast results highly may have heard confident claims somewhere. No provider can promise a timeline, and a referral conversation is a good place to reset expectations gently.

FDA approval versus fast results

These two tied in the ranking, each chosen by about a quarter of respondents. But the tie hides a difference. A separate question asked how heavily approval would count, and 59 percent answered deciding or big. Approval may not be the first thing people circle, but it is a strong background condition.

That matters because the category is crowded with look-alikes. The nasal spray Spravato, whose active ingredient is esketamine, carries FDA approval for depression that has held out against the usual treatments. IV ketamine given for depression is off label, and mail-order ketamine for home use sits further still from supervised care. A patient who assumes all of these share the same approval status can end up somewhere they did not intend. When you compare options for a patient, say which is which.

Privacy versus specialization

The two least chosen attributes each drew about one in ten respondents. Eleven percent picked privacy and 10 percent picked a veteran or first responder specialization.

Low ranking does not mean these features never matter. For a particular patient, discretion may be essential, and a clinic that understands military culture may be the only one they will trust. The data simply shows that for the typical person, these are tie-breakers rather than deciders. A discreet or specialized clinic that the patient cannot afford or reach will not help them.

How the attributes interact

The ranking becomes more useful when you treat it as a sequence rather than a list:

First filter: does the clinic accept this patient's coverage?
Second filter: can this patient realistically get there, several times, with a ride?
Third check: is the treatment the FDA-approved product, and does the patient understand the difference if it is not?
Tie-breakers: privacy needs, specialty fit, scheduling, and what the patient has heard about wait times.

The attribute that was not on the card

One factor did not appear in this question because it was asked about separately: who recommends the treatment. It outweighs everything above. Seventy-four percent of respondents singled out their own doctor's advice as the thing most likely to tip them toward trying it. Advertising reached 2 percent.

That means the referrer is not one attribute among many. You are the context in which all of them are judged. A well-matched referral, one that clears coverage and distance, is the most persuasive thing in the patient's decision.

Limits of this comparison

This is research on stated preferences, not on outcomes. It cannot predict what will help any one person, nor is it medical advice; esketamine or any alternative is appropriate only when clinical judgment and the patient's history say so.

Whenever a patient signals that they may be at risk of harming themselves, the ranking stops mattering. Follow your safety protocol and point them to the Suicide and Crisis Lifeline, which answers at all hours: the number is 988 for a call or a text, and veterans can press 1 once connected.

Methodology

We collected 443 completed responses through the Pollfish consumer panel, drawing on adults aged 18 to 64 from Minnesota, Missouri, Nebraska, Kansas, Iowa, Indiana, Illinois, Ohio, Oklahoma, and Wisconsin, and closed the survey on June 23, 2026. The provider question allowed two selections, and payer coverage allowed several, so those totals run past the full sample. We have top-line data only. The results reflect the panel after Pollfish finished its validation. Our publisher commissioned this research and covered its cost.

Covered, close, fast or FDA-approved: how patients rank providers