Health insurance and psychiatry: one peer reviewer's perspective.

For more than twenty years, discrimination against psychiatry by the health insurance industry has been a painful issue, the subject of vigorous action by organized psychiatry. A major breakthrough was the decision by the Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) in 1967 to extend coverage for outpatient psychiatric service to military dependents. From 1967 to 1970, CHAMPUS expenditures for psychiatric services increased from $90,000 to $400,000. Large sums were paid paid to unaccredited facilities, notably residential treatment centers for children (Armstrong, 1977), thus raising legitimate concerns about quality of care and inappropriate utilization. A more fundamental issue intimidates insurers, the apparent vagueness of psychiatric concepts and criteria for clinical judgments in practice (Liptzin, 1974).