This paper will discuss the different effects managed care has on the quality of mental health care for its clients. On the positive, managed care has increased availability to a cliental that would otherwise not be able to afford mental health care. On the negative, there has been a reduction in quality in order for managed care corporations to keep costs low and still make money. Proper implementation of managed mental health care would likely result in high quality, low cost mental health care.
Two decades ago hospitals were for the physically ill and asylums were for the mentally ill.
With the stigma fading from mental illness and a movement toward deinstitutionalization, this paradigm of segregation of mental and physical health care does not hold true today. A direct effect of the paradigm shift is a greater willingness on the part of the public to seek help for mental health problems. (Madonna, 2000, 6) Managed care has stepped up to fill the increasing need for inexpensive mental health care coverage.
Each year, 52 million Americans have some form of mental health problem and out of those patients 60% are members of a managed care group. (Madonna, 2000, 8) Managed mental health care’s successes and failures now bear directly on the mental wellbeing of 32 million particularly vulnerable Americans. Initially managed care was intended to be a “comprehensive approach to healthcare that included balancing cost, quality, utilization, and access.
” (Madonna, 2000, 23) In theory, this is an optimal approach to the delivery of health care and it has proven somewhat successful in the area of physical health, but it has not provided the same success in the area of mental health. Mental health is still being treated as a separate and less important aspect of health care despite the fact that some mental health disorders, such as schizophrenia, have shown higher success rates than those of common medical procedure, such as angioplasty. (Etheredge, 2002, 6)
First and foremost managed mental health care is a business and good business often prevents good medicine. Theoretically, a well implemented managed care could work well, but in order to make their stockholders happy, managed care companies do not always implement policies to help the patient. An example of this would be the common policy of company personnel making treatment decisions instead of mental health treatment providers. This organization of power raises concerns with patients and treatment providers alike.
Historically managed care organizations have not switched mental health patients to less costly forms of treatment, they have just reduced care in general, restricting access to costly medical procedures. (Madonna, 2000, 12)
One reason a stigma is placed on forms of managed care, such as health maintenance organizations (HMO), is a highly publicized practice of providing material incentives to doctors to control the amount of costly tests and medications the doctor prescribes. Before providing these material incentives the HMOs would force the doctor to sign a gag rule, preventing the physician from disclosing any information pertaining to the unethical practice. Since the doctors who participated in the bribery can not speak about the practice, there is no way to tell the impact of this practice, but one can assume that many patients received diminished treatment of illnesses, possibly resulting in harm.
It may be hard for most people to believe that there are some pros to the existence of managed care, but this may be because only 8% of the thousands of articles writen about managed mental health care in national publications have a positive influence on the reader. (Bernard ; Shulkin, 1998, p.
2110) Despite the quantity of negative press (some of it is deserved), managed mental health care does have some positive aspects. Rising cost of health care has forced employers to cut back on health care services, mental health care often being the first to go, but managed care can be a viable way to both cut costs and improve the availability of mental health care.
“Contrary to trends in other areas of healthcare, enrollment in managed behavioral healthcare is expected to increase because of the attractive cost-saving premiums.” (Coleman, 2003, p. 36) With an increase in enrollment .