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Lack of coverage drives up cost of psychological care

The June 24 Viewpoints article and editorial provide needed leadership in the effort to reform the American health care system. In balance, our health care system has much for which to be proud. However, the way we administer this system is profoundly flawed.

The free-market "corporatization" of health care funding has led to unfettered spending on big-ticket items that have nothing to do with health care excellence. For example, each subscriber dollar that goes into advertisements is an administrative dollar not spent on actual health care.

The News rightly identifies the need for a new emphasis on lifestyle issues like diet, exercise and violence, all issues that are germane to the professional expertise of doctoral psychologists. Effective psychological intervention in these areas of health care as well as psychologists' traditional focus on the areas of stress management, family crisis intervention and the treatment of psychological disorders ultimately saves health care dollars.

Yet while the costs of maintaining a psychology private practice have consistently risen, psychologists are reimbursed at levels similar to, or lower than, those established 20 years ago.

The treatment of family problems is a special problem. Insurance company benefits often omit the treatment of couples in marital crisis as a covered service.

Family psychotherapy is uniquely time-intensive and requires a complex set of clinical skills beyond those needed for individual psychotherapy. Yet insurance corporations set reimbursement rates that are identical to, or just slightly higher than, those established for individual psychotherapy.

Inexplicably, representatives of the insurance corporations consistently ignore the fundamental economic issue of "medical cost offset." Psychological services save money.

Funding an entire smoking cessation program in 2007 would be less expensive than the surgical intervention and chemotherapy for one lung cancer patient in 2037.

The effective outpatient treatment of depression correlates with lower utilization of traditional bio-medical services. This is especially pronounced when you look at utilization of services for the entire family of the person struggling with depression. This notwithstanding, outpatient psychological intervention, even when extended with a flexible benefit, is much less costly than even a brief inpatient psychiatric hospitalization.

Reasonable funding of psychological care could ultimately be a part of the solution to our sick health care system. However, as the system presently exists, important treatment issues like lifestyle unhealthiness, stress and family violence and disintegration will continue to be under-funded. Instead, Americans will continue to get fancier insurance corporation television commercials, newer corporate headquarters and higher HMO executive salaries.

James M. Shiffner is a psychologist in private practice in Buffalo.

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