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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 Un...