CHAMPUS ten-state claim experience for mental disorder: Fiscal year 1975.

Abstract

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.

Use of Services by Persons With Mental and Addictive Disorders

“…Although 44% of people receiving treatment were seen in the GM sector, this sector represented only 11 Forty-five percent of treated persons with a substance use dis¬ order were seen in SMA settings, with mental health specialists in private practice being used by the most people. Compared with affective and anxiety disorders, however, persons with a sub¬ stance use disorder made significantly fewer visits to specialists in private practice (12.1% of total visits).…”

Beneficiary choice and interprofessional participation in CHAMPUS mental health services: 1980–1987.

“…Previous analyses (Dorken, 1979(Dorken, , 1986(Dorken, , 1988 of the overall mental health utilization data under CHAMPUS have focused on fees, costs, procedures, interstate comparisons, and interprofessional comparisons, but all based on fee-for-service, plan-recognized providers. The preponderance of mental health services rendered by all professions was consistently hourly one-on-one psychotherapy.…”

Psychotherapy in the marketplace: CHAMPUS 1986.

“…Thus the use of open fee-for-service practice reported below may be in some jeopardy in the near Dorken future. (For more details on utilization in select fiscal years, see Dorken, 1977Dorken, , 1980Dorken, , 1986a…”