July 1976

The Impact of National Health Insurance on the Tasks and Practice of Psychiatry

Author Affiliations

From the Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn (Drs Astrachan and Levinson); the Department of Psychiatry, School of Medicine, Harvard University, Boston (Dr Adler); and the Connecticut Mental Health Center, New Haven (Dr Astrachan).

Arch Gen Psychiatry. 1976;33(7):785-794. doi:10.1001/archpsyc.1976.01770070015001

• Psychiatry, like all professions, is strongly affected by changes in societal expectations and economic forces. Changes in professional priorities and patterns of patient care will undoubtedly be brought about by national health insurance. Two major types of national health insurance have been proposed: comprehensive health insurance and catastrophic insurance. We do not anticipate major impact on psychiatric tasks from some form of catastrophic insurance. Comprehensive health insurance would shape and change psychiatric practice.

An examination of psychiatric tasks provides a framework for anticipating alterations in practice. We identify four major task areas in psychiatry: (1) medical tasks, (2) reparative tasks, (3) social control tasks, and (4) humanistic tasks. These tasks would be differentially influenced. Psychiatry's medical tasks will be stressed, while funding for many reparative tasks may be limited. The care of the severely ill patient may be fragmented because of problems in integrating medical and rehabilitative services.