Gardner T. Umbarger, III, M.Ed.
June 26, 1998
Your article on the horrors of managed care fails to address the shortcomings of your own profession in 1) limiting the unnecessary utilization of mental health services, 2) coordinating patient care, and 3) a lack of concensus on the most effective treatment methodologies. Before you blame all managed care a certain amount of housecleaning is in order.
Profiteering in health care is not limited to just managed care organizations. Individual therapists have defended the practice of not divulging patient status under the guise of confidentiality, but is that really the only reason? Might it also be the case that therapists do not want anyone "second guessing" their treatment methods and terminating treatment for a patient that no longer requires care? Prior to managed care there was little limit on the amount and duration of mental health services, and an awful lot of psychiatrists and psychologist drove large German sedans earned through quality patient care. Now they must earn money by improving the patient's condition as quickly and effectively as possible and drive Japanese sedans. Is it really the patient who suffers, as you would suggest, or the practioner who must reconsider their standard of living. You tell me.
The reality is that many patients, especially those needing help, are not in the position to make effective care purchasing decisions, and certainly not decisions about alternative levels of service. LCSWs are fine for many patients, and they charge less than an MD or Ph.D. practioner. Can you actually justify allowing the patient to use someone else's money to pay for more care than they really need? I certainly hope not.
Managed care is just that, managed. Just because it is managed in a way that limits the income of service providers does not mean it is necessarily a bad thing. To suggest that no one gets appropriate care from managed care is completely false and without merit. Because someone takes profits that were once the sole possession of providers is not necessarily bad, just poor planning. An equitable system would share the savings and pay you in accordance with your training, experience, and patient outcomes. Like it or not, managed care is here to stay. You can either work to make it better or allow it to dictate your practice. The choice is up to you.
Last reviewed: By John M. Grohol, Psy.D. on 15 Sep 2002
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