THE CASE FOR A SERVICES-BASED APPROACH TO PAYMENT FOR MENTAL-ILLNESS UNDER NATIONAL-HEALTH CARE REFORM

In this position paper drafted by the committee on psychopathology of the Group for the Advancement of Psychiatry, the authors discuss merit s and disadvantages of three different approaches to equitable coverag e of mental illness: coverage for selected psychiatric diagnoses, cove rage based on severity of impairment, and coverage of services, They b elieve that coverage of selected disorders has political appeal but is discriminatory and arbitrary, it is also impractical because clinicia ns may overdiagnose conditions covered by insurance and underdiagnose excluded conditions. Coverage based on severity of impairment, or disa bility, has similar limitations. The authors believe services should b e the principal basis for coverage, as under general medical insurance . The approach is nondiscriminatory, and costs can be controlled throu gh such means as managed care, changes in the payment system, or benef it design.