Managed care is harmful to outpatient mental health services: A call for accountability.

Abstract

Substantial evidence indicates that managed care is harmful to outpatient mental health services. The thesis is presented that two underlying causes of these harmful effects are (a) inappropriately focusing on cutting outpatient mental health expenses and (b) dramatically reducing outpatient services as a result of managed care economics. Due to the reduced services, it is likely that treatment quality will suffer as well. The probably negative results are as follows: denying services to many who need treatment, systematically undertreating the clients who are served, and denying psychologically necessary longer term treatment to those with moderate to severe problems. To protect against these dangers, it is recommended that managed care be held accountable for reporting its economic efficiency and the quantity of services provided. Because of the inherent weaknesses in managed care, alternative cost-control strategies are suggested.

The Influence of Payment Method on Psychologists' Diagnostic Decisions Regarding Minimally Impaired Clients

“…This literature includes numerous empirical surveys of practitioners regarding the impact of managed care on their practices (e.g., Bell, 1999;Murphy, DeBernardo, & Shoemaker, 1998;Phelps, Eisman, & Kohout, 1998;Rothbaum, Bernstein, Haller, Phelps, & Kohout, 1998), most of which have concluded that the impact has been quite negative. In addition, the literature includes nonempirical commentaries on the impact of managed care on psychotherapy (e.g., Karon, 1995;Miller, 1996), most of which describe managed care as having a detrimental effect. However, diagnosis has not been the primary focus of these surveys and commentaries.…”

Women, Mental Health, and Managed Care

“…Reductions in clinician payment increase profit. These sort of reduced payment levels and carve-outs are exclusive to the mental health payment system and may serve to inhibit access to adequate mental health care by managed care enrollees (Miller, 1996).…”

“…Fee-for-service insurers, including Medicare, occasionally still offer virtually unlimited mental health care sessions. More often, however, they will cover approximately 20 sessions per year to be used at the discretion of the consumer and the provider (Miller, 1996).…”

Changing Mental Health Gatekeeping: Effects on Performance Indicators

“…[2][3][4][5] Surprisingly few published studies have previously analyzed UM effects on outpatient mental health care. Certainly, there is a substantial body of research on utilization, cost, and sometimes quality effects of broad managed behavioral healthcare approaches such as carve-outs that does not isolate the contributions of specific techniques.…”