Commentary from a Health Economist: Financing Pediatric Psychology: On "Buddy, Can You Spare a Dime?"

Rae (this issue) succinctly lays out a number of challenges facing the pediatric psychology profession today. Not surprisingly, while concerns about professional acceptance and the ability to develop standards of care and measures for efficacy are present, the principle source of consternation is financial. Like many of their colleagues, pediatric psychologists find themselves trapped in a reimbursement model that worked two decades ago but is increasingly a poor fit today. I would like to highlight a few of the issues raised by Rae and provide an economist’s perspective on them. In particular, I will focus on the issues of: the setting in which care takes place; the types of financial relationships that may be possible; and just who should be ‘‘sold’’ on the value of pediatric psychology services. The first issue raised by Rae that deserves additional attention from the profession regards the site at which care is expected to take place. As the article points out, the traditional emphasis on having pediatric psychologists as part of the pediatric hospital staff may be less and less viable as time goes on. There are a number of difficulties with having the hospital be the modal site of care for these services. While it is undoubtedly true that such services are needed, a problem arises when the profession seeks to broaden the scope of services offered away from the support of patients and their families through an acute episode of care, and toward theongoing management of chronic conditions and prevention. Such services are not central to the mission of most hospitals and consequently are ‘‘hard sells’’ for the hospital administration. This leads to the perceived personal and professional devaluation of pediatric psychological