Managed care is a form of health care delivery that currently covers about half of American workers, and is growing rapidly. It promises to reduce the cost of healthcare coverage to employers. While some unnecessary treatment may exist, under the competitive pressure to reduce costs, managed care companies have an economic incentive to reduce all treatment. This is a serious problem in the area of mental health, where the managed care company may define adequate treatment a barely enough to release a patient from the hospital, but not enough to return him or her to normal functioning. People with mental illness are often denied access to psychiatric care until they have disabling symptoms.
Modern medicine stresses the importance of attending to small problems before they become big ones.
In mental health, for example, certain signs may indicate that a child is reacting to stresses which can become problems if left unattended. Such signs frequently accompany traumatic events, such as the loss of a family member, or parents going through a divorce. Many health plans today will pay for early cancer detection services, but will not permit a subscriber to see a psychiatrist during such a time of stress, permitting more serious symptoms to develop. A related problem arise when a patient has a chronic, or long-term, mental illness. One study found that the social and physical problems of depressed psychiatric patients treated in a managed care environment actually worsened over time, while the problems of similar patients with traditional insurance coverage did not.