Reimbursement Policy and Cost-Effective Mental Health Care

Examines past efforts to curb the cost of insuring mental health care that have involved such devices as cost-sharing, benefit ceilings, and limitations on eligible providers. More recently, attention has been turned to regulatory schemes that would employ the results of efficacy research. Specifically, public debate has focused on using demonstrated effectiveness as a criterion for approving certain treatments for reimbursement. Such a strategy may increase costs, inhibit innovation, and interfere with clinical practice. A regulatory model is proposed that would use the criterion of cost as well as the criterion of effectiveness. This method would permit effective, lower cost treatments to be substituted for high-cost therapies. Provider participation and systems innovation would be fostered through decentralized implementation. (August 1983)