Managed health care, ethics, and psychotherapy.

Abstract

Clinical psychologists express major concerns about the interplay of managed care, psychotherapy, and pmfessional ethics that center around issues of quality, quantity, and continuity of care; patient-provider autonomy; patient abandonment; third-party intrusiveness; guidelines, outcome research, utilization review; malpractice; confidentiality; truth in advertising; and allocation of resources. To guide psychologists working in today's ever-changlng health care system the current code of ethics needs revision to encourage use of accurate, empirical standards to study health care delivery; detennination of psychotherapy as an entitloment or a business; distinguishing between necessary and discretionary psychotherapy; and articulating a clear-cut social ethic that would assure fair and equal access to needed therapy for all.

Managed Mental Health Care: Intentional Misdiagnosis of Mental Disorders

“…Even though progress was made regarding cost containment, quality of care was not emphasized to the extent necessary (McCarthy, Gelber, & Dugger, 1993). As costs in health care increased, so did the number of restrictions placed by insurers on reimbursement for mental health services (Austad, Hunter, & Morgan, 1998;Bilynsky & Vernaglia, 1998;Cooper & Gottlieb, 2000). As a result, providers and consumers expressed concerns about diminishing access to needed services as health care service delivery moved from traditional fee-for-service providers (e.g., consumers purchased insurance from a commercial carrier, paid a deductible, and chose their physician separately; Huber, 1995) to managed care providers (Huff, 2000).…”

Conflicts of Interest and Management in Managed Care

“…A patient's inability or unwillingness to adapt to change may be a less reliable indicator of a loss of trust or erosion of the fiduciary relationship created by managed care than a description of a dependency relationship that itself needs critical assessment. 21 Poor communication is probably a far more pervasive and George J. Agich and Heidi Forster significant component in the loss of trust in physician-patient relationships than external factors, such as a loss or restriction on freedom of choice of provider. Ultimately, the justification of continuity of care will have to be grounded in data showing its actual contribution to improving patient wellbeing.…”

Ethical Issues with Managed Care

“…However, the federal government accepted some of this burden as well through programs for the elderly (Medicare), the disabled (Medicaid), and federal workers (CHAMPUS). Nevertheless, at this time more than 40 million Americans, many of whom are employed, have no health insurance at all (Austad, Hunter, & Morgan, 1998). It is important to note that the United States is the only industrialized country other than South Africa that does not offer health care to all citizens (Corcoran & Vandiver, 1996).…”

“…Given this new terrain, a recent report by the CAPP Task Force on Ethical Practice (1998) urged psychologists to refamiliarize themselves with APA's (1992) "Ethical Principles of Psychologists and Code of Conduct." However, the most recent revision of the APA ethics code (APA, 1992), although offering general guidance with these issues, is not always of adequate assistance in the ethical decision-making process (Austad et al, 1998;Gottlieb, 1992). In part, this is due to the fact that the revised ethics code (APA, 1992) was developed before the impact of managed care had been fully felt.…”

“…As a result, we strongly recommend that the practitioner not use e-mail communication to discuss confidential client material. It is hoped that the APA's (1992) ethics code will be updated to reflect these technological advances in information exchange (Austad et al, 1998).…”