The health of the psychiatric services industry could hinge on the generosity of health reformers in 1994.
Clinton's original health proposal called for 60 days of inpatient care a year-30 days per episode-until the year 2000 when states will set their own parameters.
However, the Clinton administration now intends to cut back its basic benefits package to 30 days per year. "Quite candidly, we're disappointed that more and more limitations" are being put on mental health benefits, said Robert Trachtenberg, executive director of the National Association of Psychiatric Health Systems in Washington. "Hopefully, it's going to be seen a little differently in the Congress."
Obviously, the battle is far from over, and the NAPHS, which represents private hospital-based psychiatric systems, will lobby hard to keep mental health at the bargaining table.
Mr. Trachtenberg is optimistic about mental health's role in healthcare reform. Reform "is going to bring a lot more people into the system," he said. Psych providers have long deplored the sometimes arbitrary limits payers place on services, and many employers offer less coverage than the Clinton plan provides.
Psychiatric providers sometimes argue that a mentally healthy population will use less of the other medical services. The National Institute of Mental Health recently reported that mental illness and substance abuse costs society $273 billion annually.
The demand for psychiatric and substance-abuse treatment won't go away, but the mix of providers may change.
Nearly all of the hospital chains have jettisoned unprofitable hospitals. More of that is expected to continue in 1994, especially if a basic benefits package doesn't include mental health. Some psychiatric providers also could be hurt by local hospital systems that build networks and shut out freestanding providers.
Savvy private providers, however, won't let that happen and will work even harder to integrate into a system that can contract with payers.