The problems of managed care tied to the reimbursement problems argue that we need real health reform. The likelihood is that only a one payee government system will address these problems fairly. We need universal health care coverage. No individual should be endangered by virtue of illness of also being economically destitute. The effects of the managed care system are problematic both on the quality of health and mental health care given.
Many doctors avoid managed care in whatever way they can.
If they have an established and substantial practice, they simply will not participate. That is not to say that we can be casual about the cost of health care and the appropriate cost of mental health care. A system has to include reasonable controls so that we do not break the bank, but if anything the pendulum has tilted too much in the direction of business principles and managing costs rather than really promoting health care. Psychiatry, along with other medical disciplines, should be actively thinking of ways to contribute to a national solution regarding health care reimbursement. Patient education, greater attention to research to bring more therapeutic advances, comprehensive treatment with attention to prophylaxis and prevention which can reduce costly acute care and hospital care, can all be part of that answer.