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Book Review

Health Care Reform: A Primer for Psychiatrists

James H. Shore, MD

Published: March 15, 2013

Health Care Reform: A Primer for Psychiatrists

American Psychiatric Association, with guest editor Thomas G. McGuire, PhD. American Psychiatric Association, Washington, DC, 2012, 29 pages, $30.95 (paper).

The Patient Protection and Affordable Care Act (PPACA) creates many opportunities and uncertainties for Psychiatry. This brochure, published by the American Psychiatric Association, was commissioned by the US Department of Health and Human Services. It was edited by Thomas G. McGuire of Harvard’s Department of Health Care Policy and consists of 3 articles, which cover proposed insurance exchanges and mental health implications, PPACA benefits for mental health and substance use disorders, and behavioral health and primary care collaboration opportunities in health care reform.

The first article, by McGuire and Sinaiko, focuses on the proposed health insurance exchanges with state, private outsource, or federal sponsorship. Exchanges are planned to promote competition and choice. A primary concern addresses the problems that can be created by adverse selection of higher-risk psychiatric patients in the exchanges. The exchanges are based in part on Massachusetts’ model, the Health Connector, and will cover a defined minimum benefit package with mental health parity and subsidies for lower-income recipients. On an optimistic note, the article points out that the Federal Employees Health Benefits Program implements better parity at little net cost to that program. In spite of the significant complexity as some individual states decentralize the plan, the author emphasizes an advantage for the application of a coordinated strategy of integrated health care benefits.

The second article, by Garfield, Lave, and Donohue, reviews the coverage expansion for mental health and substance use disorders. It summarizes current coverage of behavioral health services by major national payers. Many needed services for mental health and substance use disorders patients fall outside current benefits. This will need to be addressed by future regulations or legislation. From this article, it is obvious that the PPACA did not conclude the fight for parity, but just continued it at a higher-stakes level.

The final article, by Druss and Mauer, discusses the opportunity for reform at the behavioral health-primary care interface. It reviews 2 demonstration projects with potential to facilitate this interface, a medical home program and a colocation project of behavioral health and primary care. It includes a review of important supporting program components, such as financial models, quality assurance, and applications of information technologies.

This publication anticipates health care reform issues for psychiatrists and is an informative current overview of key aspects of the reform process. It highlights the opportunities, complexities, and uncertainties in the implementation of the PPACA and the challenges for parity.

James H. Shore, MD

Author affiliation: University of Colorado School of Medicine, Denver, Colorado.

Potential conflicts of interest: None reported.

Volume: 74

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