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

Letter from America: how will health reform affect psychiatric care?

“…As medical tasks (Astrachan 1976) have expanded and subspecialisation has grown, one key question is whether there will be enough psychiatrists willing to treat all the additional individuals who may benefit from treatment. This is particularly true in the case of child and adolescent psychiatrists, who are very much in short supply.…”

Acute and chronic psychiatric care: Establishing boundaries

“…A single system of comprehensive psychiatric care could provide what Astrachan and Sharfstein have described as the four major components of care: medical (acute care), reparative (chronic care), humanistic (personal growth and development), and social control (e.g., socially deviant and dangerous behaviors that are a consequence of mental and addictive disorders). (15,16) One system of care could span these components and need not segregate out the indigent. In fact, unless public and private monies are adequately pooled, comprehensive, cost-effective services cannot be achieved because of the duplicative and fragmented care systems that emerge from two tiered financing schemes.…”

Reform Issues for Insuring Mental Health Care

“…In a 1976 paper Boris Astrachan and coauthors discussed the potential impact of national health insurance on the tasks and practice of psychiatry. 5 They elaborated the four major tasks included in comprehensive psychiatric care. Here we discuss each of these tasks and their financing in the current health care system.…”