Reform Issues for Insuring Mental Health Care

Prologue: As insurance comes under the scrutiny of health care reformers, differences in the treatment of general medical care and mental health care emerge. In this essay psychiatrists Steven Sharfstein and Anne Stoline offer a road map for policymakers through the various components of psychiatric care—both medical and nonmedical—and put forth their proposals for reforming the insurance of such care. As Sharfstein explained, “The crisis in psychiatric care and its financing requires a rethinking of old assumptions and a reinventing of methods of payment based on new needs and new realities.” The analysis presented here “will assist legislators in developing a rational policy for the financing of psychiatric treatment and supportive services for the mentally ill,” write the authors. Sharfstein is president, medical director, and chief executive officer of the Sheppard and Enoch Pratt Hospital, a private, nonprofit psychiatric hospital in Baltimore, Maryland, and clinical professor of psychiatry at the University of Maryland. Trained as a psychiatrist at the Massachusetts Medical Center, he also holds a master s degree in public administration from Harvard University. Sharfsteins strong interest in and analysis of mental health care financing have led to six books and over a hundred articles. He is well versed in the financing issues of both the public and private sectors, having examined public financing during thirteen years in the U.S. Public Health Service, and private financing and managed care issues during the past decade in the private sector. Stoline is staff psychiatrist at Springfield Hospital Center, a state psychiatric hospital in Sykesville, Maryland. She completed her psychiatric residency at The Johns Hopkins University in June. While in medical school at Hopkins she wrote, with Jonathan Weiner, the widely acclaimed book, The New Medical Marketplace: A Physician's Guide to the Health Care Revolution , whose second edition is due out next spring.