Managing Managed Care

The introduction of the concept of managed care into mental and physical health care appears to be a juggernaut of unparalleled impact. The two extremes of thought about this impact are (I) that managed care is a villainous foe to be resisted in order to bring back the earlier halcyon years of independence in practice decisions with greater reimbursement for psychologists' services or (2) that managed care is a laudatory attempt to restrain health care costs that are out of control and spiraling upward by rooting out mismanagement and reversing financial incentives to provide unnecessary care. The former view calls managed health care such names as "mangled care" and distributes bumper stickers stating "Just Say No to HMOs. " The latter view points to the slowdown of increases in health care expenditures and the enhancement of health care affordability and appropriateness for greater numbers of persons resulting from managed care cost-containment strategies and service review procedures. Mental or behavioral health care has been as strongly impacted as medical care under managed care. Where managed care has forced practitioners' attention to validated procedures and to examining previous wasteful practices, we ap­ plaud the movement. Where managed care has had adverse impact, we think there needs to be greater public, legal, and regulatory attention to its excesses and abuses.