Abstract
This study examined the effect of the Civilian Health and Medical Plan of the Uniformed Services (CHAMPUS) Reform Initiative (CRI) in Hawaii. Data are presented from 1986-1991 on the professions involved, outpatient and inpatient services rendered, and psychotherapy fees by profession. This medical gatekeeper model of managed care, based on a system of referral to specialist services by primary care physicians and developed by a Hawaii medical group, yielded predictable results. Whereas psychologists had been the dominant providers of outpatient mental health services since 1980 and had a minor presence in inpatient services, the implementation of CRI resulted in psychiatrists becoming the dominant outpatient provider and psychologists essentially being eliminated from hospital practice.
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