Basic issues in managed mental health services.

Abstract

By all accounts, the traditional form of mental health care delivery, whereby patients are free to choose their providers and third-party payors assume most of the financial risk, is on the decline. In its place, a wide array of so-called alternative health care delivery systems have emerged, called collectively, "managed health care" systems. One of the primary aims of managed-care systems is to control costs, using a variety of cost-containment and cost-shifting mechanisms, including requiring the patient to pay a greater share of the cost of care, placing a cap on benefits received by third-party payors, and limiting the choice of providers to a preselected group. As providers, psychologists' need to be aware of the clinical and financial implications of these emerging systems in order to function effectively and influence the design of such systems.This chapter has three major sections. In the first section, we describe the basic types of managed-care systems, and in the second we delineate the ways in which psychologists may participate in them. In the last section, we discuss the various professional relationship and professional practice issues that affect providers who work in these settings. An Overview of the Four Most CommonManaged-Care Systems Health Maintenance OrganizationsA health maintenance organization (HMO) is a n organized system of health care that enlists the services of hospitals, physicians, and other professionals to provide all medically necessary health care, including mental health, for a defined population, typically in return for a capitated payment. HMO healthWe gratefully acknowledge the useful comments and other contributions made by Shirley lThroughout this chapter, the term psychologist(s) should, for the most part, be read as beiilg Ann Higuchi, Rodney L. Lowman, and several anonymous reviewers.synonymous with mental health professzonds).

Introduction to the special section on assessment in psychological treatment: A necessary step for effective intervention.

“…Managed mental health care factors, particularly the restrictions on sessions, can influence the quality of treatment (Resnick, Bottinelli, Puder-York, Harris, & O’Keefe, 1994). In addition to austere session limits that some managed care organizations are imposing, less well-trained therapists (bachelors and masters level) who work at lower fees to provide therapy also serve to limit treatment effectiveness (Karon, 1995).…”