The impact of national health insurance on the tasks and practice of psychiatry
B. M. Astrachan, D. J. Levinson and D. A. Adler
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.
