The utilitization of mental health services by beneficiaries under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) for fiscal year 1975 is described in detail, including -tabular presentation by treatment procedure, diagnosis, profession, state, and average fees. Some interpretative comments are offered, as well as trend comparisons with utilization in the 2 prior years. Since qualified psychologists are now recognized by federal law as independent providers in this program, the data are of special significance to the profession of psychology.Broad and comprehensive utilization data on insured mental health services are rare indeed. Frequency of utilization and proportion of total cost are basic parameters for which few reports are available (see chaps. 10 and 11, Dorken & Associates, 1976). What makes the CHAMPUS data truly unique is not only the indices of visit frequency by type of mental disorder and whether inpatient or outpatient service, but basic data by procedure, by provider, and by state (for 10 states) together with fee information.The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), with an estimated 6.31 million beneficiaries in the 50 states and the Washington, B.C., area in calendar year 1974, is the single largest group health plan in the nation. Although similar in structure in many respects, CHAMPUS is not an insurance program because there is no contract guaranteeing indemnification of specified loss in return for a premium paid. Moreover, the program is not subject to state regulatory bodies which control the insurance business. The basic program is essentially a supplemental program to the uniformed services direct medical care system.

In 1977 a survey of health service practice by licensed/certified psychologists was sent to licensed psychologists in 10 states, a sample comprising about half of the licensed psychologists in the nation. About half responded to the highly detailed 57-section questionnaire. Data were obtained on (a) health service practitioner psychologists ' education, public training support, mobility, and distribution; (b) the scope and dimensions of psychologists'feefor-service practices; (c) the extent of psychologists' practices in hospital settings; (d) psychologists' fees and incomes; (e) insurance reimbursement experience; (fi experience with projessional standards review committees; and (g) a cross-section description of clients seen by fee-jor-service psychologists. This article contrasts these survey results with those of several previous comparable surveys. The results clearly show that the practicing psychologist has an active and growing, but recent, presence in health care, particularly in jee-jor-service modes of practice. However, hospital practice and health insurance reimbursement procedures have not yet fully integrated clinical psychologists into the generic health care system.

Considered from the perspective of licensed psychologists in fee-for-service practice, the extent of medical staff membership and clinical privileges are tabulated and described. The hospital practice of psychology, although still proportionally quite limited, is viewed in the context of interpnofessional competition and current trends. One fifth of fee-for-service licensed psychologists report membership on the medical staff of a hospital (one fourth if those with affiliate status are added). One fifth of fee-for-service licensed psychologists have formal privileges, whereas almost one third report some type of clinical privilege based on formal agreement or informal arrangement. These data on hospital practice were derived from a direct questionnaire survey of all licensed psychologists in 10 states.

Tracking the licensed psychologists in 10 target states revealed a 12% increase from 1974 to 1976 and a further 27 % increase in the next three years, or a 42% growth over this five-year (1974-1979) period. Given an unduplicated count of 25,510 licensed psychologists nationally in 1976, these trends suggest a national projection, as of 1980, of 35,100 licensed psychologists residing in the United States, of whom 24,300 are clinically active doctoral-level, health service providers. Policy implications and variations among the states are discussed.It is alleged that Edwin C. Boring, making a longterm statistical projection based on a continuing increase in membership in the American Psychological Association, once commented that by the year X, "There will be more psychologists than people in this country!" Leaving the long-term future aside, it is now apparent that the increase of licensed psychologists over the five years from 1974 to 1979 has been quite dramatic.

Drawing from utilization data for fiscal year 1986 and prior years of the Civilian Health and Medical Program of the Uniformed Services, the single largest health plan in the country, we see continued growth in the number of practitioners providing mental health services and a continuing penetration into the health care market by psychologists though with wide variation among states. While the range of mental health procedures which can be provided is substantial, hourly individual psychotherapy is the predominant procedure accounting for almost three quarters of all outpatient visits and over half the inpatient visits. In several respects this major federal plan provides a current perspective on fee-for-service patterns of practice.The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) is the single largest health plan in the nation. As a militaryrelated benefit, comprehensive health care is available to dependents of active-duty personnel and to retired military and their dependents or survivors. In 1986 there were 6.295 million persons eligible for CHAMPUS benefits, not many fewer than the 6.324 million eligible in 1981. Recognition for clinical psychologists under the CHAMPUS The cooperation of CHAMPUS in supplying the fiscal year data and particularly of Mr. Rich Barnett, Chief of Statistics, for helpful personal clarification is very much appreciated and made this article possible.