This investigation focused on the impact of the marketplace upon fee, fee structure, and methods of reimbursement employed by psychotherapeutic practitioners.

Psychiatrists and psychiatric Nurse Practitioners were surveyed by mail using the Psychotherapeutic Market Survey (PMS) in Dallas, Texas, Los Angeles, and San Francisco, California. The survey questionnaire consists of 19 forced choice questions and two modified open-ended questions. Data were analyzed using simple frequency distributions. Inferential as well as nonparametric statistics were employed for hypotheses testing.

No significant difference was found in fees assessed by psychiatrists in a competitive marketplace (California) versus fees assessed by psychiatrists in a noncompetitive marketplace (Texas). Furthermore no significant difference was found in fees collected directly by psychotherapeutic nurse practitioners versus those fees collected indirectly by the psychotherapeutic nurse practitioner. No significant difference in fees structures was found when practice setting was examined. A moderately positive correlation (0.457) between the number of patients served and the individual fee amount assessed for services was found.

All practitioners accepted cash for payment. Insurance was the second method most used for reimbursement regardless of state. Other methods of reimbursement were not used frequently enough to warrant exploration. A significant difference in fees assessed was found between psychotherapeutic nurse practitioners and psychiatrists for similar services rendered in the same locality. San Francisco was highly significant in all therapeutic modalities; Individual Psychotherapy (F = 173.28, p $<$ 0.001), Group Therapy (F = 79.70, p $<$ 0.001), Marriage Therapy (F = 228.32, p $<$ 0.001), Family Therapy (F = 277.20, p $<$ 0.001), Child/Adolescent Therapy (F = 478.80, p $<$ 0.001), and Substance Abuse Therapy (F = 1501.00, p $<$ 0.001); just as Los Angeles was, Individual Psychotherapy (F = 114.91, p $<$ 0.001), Group Therapy (F = 19.46, p $<$ 0.001), Marriage Therapy (F = 124.50, p $<$ 0.001), Family Therapy (F = 200.30, p $<$ 0.001), Child/Adolescent Therapy (F = 132.49, p $<$ 0.001), and Substance Abuse Therapy (F = 217.23, p $<$ 0.001).

It was found the fees charged the consumer for individual therapy increased as the patient load increased (F = 0.457; p $<$ 0.001). This study demonstrates the greater the number of a type of seller is found in a marketplace, fees are driven downward. San Francisco's psychiatrists charged significantly less for individual psychotherapy than psychiatrists in Los Angeles and Dallas (F = 25.50, p $<$ 0.001). (Abstract shortened with permission of author.).